| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $708.89 | $6,374.00 | $16,594.55 | |
Aetna
| Facility | 52 | $354.45 | $354.45 | $354.45 |
Aetna
| Facility | 53 | $141.78 | $141.78 | $141.78 |
United
| Facility | $3,960.00 | $15,299.00 | $30,920.00 |