| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $768.90 | $6,933.63 | $6,933.63 | |
Medica
| Facility | $768.90 | $1,217.11 | $2,306.69 |
Rpr/Advmnt Tdn W/Ntc Supfcis Tdn Prim Ea Tdn
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $768.90 | $6,933.63 | $6,933.63 | |
Medica
| Facility | $768.90 | $1,217.11 | $2,306.69 |