| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $100.00 | $157.76 | $2,341.64 | |
Aetna
| Facility | 52 | $34.61 | $78.88 | $78.88 |
Aetna
| Facility | 53 | $13.85 | $31.55 | $31.55 |
Anthem BCBS
| Facility | $1,223.09 | $1,426.62 | $2,500.00 | |
United
| Facility | $75.00 | $3,360.00 | $7,448.00 |