| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $231.75 | $231.75 | $8,500.00 | |
Aetna
| Facility | 50 | $16,375.65 | $16,375.65 | $16,375.65 |
Medica
| Facility | $231.75 | $326.06 | $695.25 | |
United
| Facility | $5,025.00 | $5,025.00 | $5,025.00 |