| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $324.47 | $324.47 | $8,500.00 | |
Aetna
| Facility | 52 | $162.24 | $162.24 | $162.24 |
Aetna
| Facility | 53 | $64.89 | $64.89 | $64.89 |
Medica
| Facility | $324.41 | $444.23 | $949.89 | |
United
| Facility | $1,530.00 | $1,530.00 | $1,530.00 |