| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,129.01 | $2,129.01 | $2,129.01 | |
Medcost
| Facility | $891.29 | $1,379.33 | $1,844.62 |
Opn Subcla Crtd Art Trpos Nck Inc Ulat
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,129.01 | $2,129.01 | $2,129.01 | |
Medcost
| Facility | $891.29 | $1,379.33 | $1,844.62 |