| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $199.84 | $199.84 | $8,500.00 | |
Aetna
| Facility | 52 | $99.92 | $99.92 | $99.92 |
Aetna
| Facility | 53 | $39.97 | $39.97 | $39.97 |
Medica
| Facility | $199.84 | $307.60 | $590.00 | |
United
| Facility | $681.00 | $681.00 | $681.00 |