| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,630.75 | $1,630.75 | $8,500.00 | |
Aetna
| Facility | 52 | $815.38 | $815.38 | $815.38 |
Medica
| Facility | $1,511.49 | $2,044.26 | $3,526.15 | |
United
| Facility | $681.00 | $681.00 | $681.00 |