| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $609.50 | $2,444.00 | $16,520.47 | |
Aetna
| Facility | 52 | $54.72 | $54.72 | $617.07 |
Medica
| Facility | $107.56 | $878.09 | $1,861.65 | |
Medica
| Facility | 52 | $341.53 | $341.53 | $341.53 |
United
| Facility | $100.00 | $610.00 | $1,883.00 |