| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $755.09 | $755.09 | $8,500.00 | |
Aetna
| Facility | 52 | $377.55 | $377.55 | $377.55 |
Medica
| Facility | $755.09 | $1,027.58 | $1,967.70 | |
United
| Facility | $1,980.00 | $1,980.00 | $1,980.00 |