| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,788.74 | $1,788.74 | $8,500.00 | |
Aetna
| Facility | 52 | $894.37 | $894.37 | $894.37 |
Medica
| Facility | $1,613.57 | $2,243.60 | $3,867.30 | |
United
| Facility | $681.00 | $681.00 | $681.00 |