| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $750.00 | $3,000.00 | $10,095.45 | |
Aetna
| Facility | 52 | $347.42 | $347.42 | $1,733.44 |
Aetna
| Facility | 53 | $138.97 | $138.97 | $693.37 |
Cigna
| Facility | $1,000.00 | $1,000.00 | $1,000.00 | |
United
| Facility | $985.00 | $3,956.00 | $10,251.00 |