| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $38.36 | $102.09 | $136.11 |
Medica
| Facility | 26 | $79.90 | $190.00 | $190.00 |
Rp Loclzj Tum Plnr 2+Area 1+D Img/1 Area Img>2+D
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $38.36 | $102.09 | $136.11 |
Medica
| Facility | 26 | $79.90 | $190.00 | $190.00 |