| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,500.00 | $4,500.00 | $5,519.00 | |
Moda Health
| Facility | $2,515.37 | $3,787.48 | $5,620.90 | |
United
| Facility | $3,700.00 | $15,298.00 | $26,104.00 |
Rescj/Exc Les Infratempor Fossa Space Apex Xdrl
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,500.00 | $4,500.00 | $5,519.00 | |
Moda Health
| Facility | $2,515.37 | $3,787.48 | $5,620.90 | |
United
| Facility | $3,700.00 | $15,298.00 | $26,104.00 |