| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $109.43 | $246.93 | $2,000.00 | |
Medica
| Facility | $109.43 | $246.93 | $422.48 |
Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/Img Gdn
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $109.43 | $246.93 | $2,000.00 | |
Medica
| Facility | $109.43 | $246.93 | $422.48 |