| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $478.63 | $2,398.83 | $9,772.37 | |
Harvard Pilgrim
| Facility | $12,302.69 | $12,302.69 | $12,302.69 | |
United
| Facility | $12,302.69 | $12,302.69 | $12,302.69 | |
Well Sense
| Facility | $234.42 | $234.42 | $380.19 | |
Well Sense
| Facility | 62 | $134.90 | $134.90 | $134.90 |