| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $750.00 | $1,550.00 | $8,332.37 | |
Aetna
| Facility | 52 | $369.82 | $369.82 | $622.54 |
Aetna
| Facility | 53 | $147.93 | $147.93 | $249.01 |
Cigna
| Facility | $2,900.00 | $3,975.00 | $16,742.18 | |
United
| Facility | $1,185.00 | $6,023.00 | $12,556.00 |