| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,227.83 | $4,387.00 | $16,449.00 | |
Aetna
| Facility | 52 | $613.91 | $613.91 | $613.91 |
Aetna
| Facility | 53 | $245.57 | $245.57 | $245.57 |
United
| Facility | $2,912.00 | $7,693.00 | $13,847.00 |