| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $770.48 | $770.48 | $9,500.00 | |
Aetna
| Facility | 54 | $577.86 | $577.86 | $577.86 |
Medica
| Facility | $770.48 | $1,088.70 | $2,311.44 | |
United
| Facility | $2,545.00 | $2,545.00 | $2,545.00 |