| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $20.83 | $20.83 | $20.83 | |
Aetna
| Professional | $20.83 | $20.83 | $29.28 | |
Medica
| Facility | $29.28 | $35.20 | $80.23 |
Php/Iop Ot Service
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $20.83 | $20.83 | $20.83 | |
Aetna
| Professional | $20.83 | $20.83 | $29.28 | |
Medica
| Facility | $29.28 | $35.20 | $80.23 |