| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $403.17 | $403.17 | $8,500.00 | |
Aetna
| Facility | 54 | $302.38 | $302.38 | $302.38 |
Medica
| Facility | $403.17 | $513.10 | $727.41 | |
United
| Facility | $3,105.02 | $3,105.02 | $3,105.02 |