| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,481.91 | $6,374.00 | $13,591.41 | |
Aetna
| Facility | 50 | $8,267.45 | $8,267.45 | $8,267.45 |
Aetna
| Facility | 52 | $740.96 | $740.96 | $740.96 |
United
| Facility | $1,981.00 | $3,613.00 | $7,048.00 |