| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $28.84 | $28.84 | $28.84 |
Medcost
| Facility | 26 | $56.15 | $67.00 | $117.93 |
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 | $28.84 | $28.84 | $28.84 |
Medcost
| Facility | 26 | $56.15 | $67.00 | $117.93 |