| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $101.16 | $101.16 | $8,500.00 | |
Medica
| Facility | $101.16 | $131.51 | $220.19 | |
United
| Facility | $125.00 | $125.00 | $125.00 |
Bx Lvr Ndl Done Purpose Tm Oth Major Px
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $101.16 | $101.16 | $8,500.00 | |
Medica
| Facility | $101.16 | $131.51 | $220.19 | |
United
| Facility | $125.00 | $125.00 | $125.00 |