| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,218.22 | $1,218.22 | $8,500.00 | |
Aetna
| Facility | 52 | $609.11 | $609.11 | $609.11 |
Medica
| Facility | $1,141.41 | $1,583.69 | $2,631.92 | |
United
| Facility | $681.00 | $681.00 | $681.00 |