| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,184.22 | $1,184.22 | $1,184.22 | |
Medica
| Facility | $55.00 | $1,233.68 | $4,552.00 |
Opn Subcla Crtd Art Trpos Nck Inc Ulat
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,184.22 | $1,184.22 | $1,184.22 | |
Medica
| Facility | $55.00 | $1,233.68 | $4,552.00 |