| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $87.57 | $125.82 | $400.00 |
Work Related/Med Dblt Xm Oth/Thn Treating Phys
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $87.57 | $125.82 | $400.00 |