| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $198.68 | $198.68 | $198.68 | |
University Health Alliance
| Professional | $146.80 | $146.80 | $164.42 |
Unlisted Diagnostic Radiographic Procedure
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $198.68 | $198.68 | $198.68 | |
University Health Alliance
| Professional | $146.80 | $146.80 | $164.42 |