| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,063.89 | $4,540.00 | $10,871.00 | |
Aetna
| Facility | 52 | $531.95 | $531.95 | $1,030.20 |
Aetna
| Facility | 53 | $212.78 | $212.78 | $412.08 |
United
| Facility | $1,627.00 | $6,590.00 | $10,536.00 |