| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $57.88 | $57.88 | $57.88 |
Medcost
| Facility | 26 | $99.00 | $126.00 | $235.56 |
Card Bl Pool Plnr Mlt Stdy Wal Motn Eject Fract
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $57.88 | $57.88 | $57.88 |
Medcost
| Facility | 26 | $99.00 | $126.00 | $235.56 |