| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $100.00 | $478.63 | $9,772.37 | |
Harvard Pilgrim
| Facility | $3,388.44 | $3,388.44 | $7,413.10 | |
United
| Facility | $3,388.44 | $3,388.44 | $7,413.10 | |
Well Sense
| Facility | $114.82 | $114.82 | $114.82 |