| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $107.10 | $107.11 | $134.94 |
Health Alliance Plan
| Facility | 26 | $107.10 | $112.46 | $169.36 |
Programmed Stimj & Pacg After Iv Drug Nfs
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $107.10 | $107.11 | $134.94 |
Health Alliance Plan
| Facility | 26 | $107.10 | $112.46 | $169.36 |