| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $772.73 | $4,933.00 | $4,933.00 | |
BCBS
| Facility | $532.32 | $627.91 | $883.44 | |
Health Alliance Plan
| Facility | $626.65 | $772.73 | $4,933.00 | |
United
| Facility | $464.00 | $1,209.00 | $1,844.00 |