| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $788.98 | $7,838.38 | $7,838.38 | |
Aetna
| Facility | 52 | $394.49 | $394.49 | $394.49 |
Providence
| Facility | $699.06 | $889.71 | $1,048.64 | |
United
| Facility | $3,085.00 | $4,262.00 | $17,636.00 |