| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $125.89 | $2,884.03 | $4,897.79 | |
BCBS
| Facility | $91.20 | $218.78 | $218.78 | |
Health Alliance Plan
| Facility | $218.78 | $2,884.03 | $4,897.79 | |
United
| Facility | $1,258.93 | $2,951.21 | $5,623.41 |