| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $615.00 | $1,223.00 | $2,250.00 | |
Aetna
| Facility | 52 | $252.39 | $252.39 | $252.39 |
Aetna
| Facility | 53 | $100.95 | $100.95 | $100.95 |
BCBS
| Facility | $1,292.50 | $1,568.51 | $2,110.16 | |
United
| Facility | $625.00 | $1,738.00 | $3,360.00 |