| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $458.24 | $458.24 | $8,500.00 | |
Aetna
| Facility | 52 | $229.12 | $229.12 | $229.12 |
Aetna
| Facility | 53 | $91.65 | $91.65 | $91.65 |
Medica
| Facility | $458.24 | $680.93 | $57,869.74 |
Insj Eltrd Car Ven Sys Tm Insj Dfb/Pm Pls Gen
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $458.24 | $458.24 | $8,500.00 | |
Aetna
| Facility | 52 | $229.12 | $229.12 | $229.12 |
Aetna
| Facility | 53 | $91.65 | $91.65 | $91.65 |
Medica
| Facility | $458.24 | $680.93 | $57,869.74 |