| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $633.22 | $8,960.00 | $46,397.27 | |
Aetna
| Facility | 52 | $316.61 | $316.61 | $630.90 |
Aetna
| Facility | 53 | $126.64 | $126.64 | $252.36 |
BCBS
| Facility | $13,529.38 | $41,480.12 | $80,893.28 | |
Medcost
| Facility | $470.15 | $702.20 | $1,044.42 | |
United
| Facility | $3,960.00 | $24,825.00 | $47,173.00 |