| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $250.92 | $3,272.40 | $3,993.30 | |
Aetna
| Facility | 52 | $125.46 | $125.46 | $125.46 |
Medica
| Facility | $250.92 | $373.51 | $2,458.44 | |
United
| Facility | $1,530.00 | $1,530.00 | $1,530.00 |