| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $66.51 | $271.14 | $2,000.00 | |
Medica
| Facility | $66.51 | $233.63 | $493.31 | |
United
| Facility | $450.00 | $450.00 | $450.00 |
Sgmdsc Flx Dired Sbmcsl Njx Any Sbst
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $66.51 | $271.14 | $2,000.00 | |
Medica
| Facility | $66.51 | $233.63 | $493.31 | |
United
| Facility | $450.00 | $450.00 | $450.00 |