| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $859.55 | $8,723.90 | $19,264.00 | |
Aetna
| Facility | 52 | $429.78 | $429.78 | $656.89 |
Aetna
| Facility | 53 | $171.91 | $171.91 | $262.76 |
United
| Facility | $5,682.00 | $9,969.00 | $19,696.00 |