| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $55.53 | $55.54 | $55.54 | |
Harvard Pilgrim
| Professional | $74.06 | $124.18 | $182.26 | |
Well Sense
| Professional | $2,500.00 | $2,975.00 | $4,024.75 |
Unlisted Therapeutic Proph/Dx Iv/Ia Njx/Nfs
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $55.53 | $55.54 | $55.54 | |
Harvard Pilgrim
| Professional | $74.06 | $124.18 | $182.26 | |
Well Sense
| Professional | $2,500.00 | $2,975.00 | $4,024.75 |