| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,926.61 | $7,655.00 | $13,151.00 | |
Aetna
| Facility | 53 | $535.89 | $535.89 | $585.32 |
Medica
| Facility | $55.00 | $2,232.87 | $4,935.26 | |
United
| Facility | $783.00 | $1,743.00 | $8,198.00 |