| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $770.29 | $770.29 | $10,000.00 | |
Aetna
| Facility | 52 | $385.15 | $385.15 | $385.15 |
Aetna
| Facility | 53 | $154.06 | $154.06 | $154.06 |
Medica
| Facility | $770.29 | $977.38 | $2,310.87 |