| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $793.00 | $793.00 | $10,000.00 | |
Aetna
| Facility | 54 | $594.75 | $594.75 | $594.75 |
Medica
| Facility | $793.00 | $1,114.70 | $2,379.00 | |
United
| Facility | $2,545.00 | $2,545.00 | $2,545.00 |