| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $88.16 | $148.07 | $2,000.00 | |
Medica
| Facility | $88.16 | $148.07 | $251.72 |
Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/O Img Gdn
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $88.16 | $148.07 | $2,000.00 | |
Medica
| Facility | $88.16 | $148.07 | $251.72 |