| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $615.00 | $1,223.00 | $2,250.00 | |
Aetna
| Facility | 52 | $40.49 | $40.49 | $40.49 |
Aetna
| Facility | 53 | $16.20 | $16.20 | $16.20 |
BCBS
| Facility | $895.23 | $1,086.41 | $1,461.57 | |
United
| Facility | $250.00 | $896.00 | $1,670.00 |