| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $960.52 | $2,500.00 | $9,477.00 | |
Aetna
| Facility | 52 | $480.26 | $480.26 | $831.08 |
Aetna
| Facility | 53 | $192.10 | $192.10 | $332.43 |
United
| Facility | $1,565.00 | $2,828.00 | $6,992.00 |