| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $100.00 | $2,678.80 | $9,859.00 | |
Aetna
| Facility | 50 | $4,821.32 | $6,598.80 | $13,689.00 |
Anthem BCBS
| Facility | $9,905.40 | $11,006.00 | $17,487.00 | |
United
| Facility | $12,399.00 | $12,399.00 | $12,399.00 |