| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $40.90 | $40.90 | $8,500.00 | |
Aetna
| Facility | 52 | $20.46 | $20.46 | $20.46 |
Aetna
| Facility | 53 | $8.18 | $8.18 | $8.18 |
Medica
| Facility | $40.76 | $53.18 | $118.18 | |
United
| Facility | $125.00 | $125.00 | $1,978.00 |