| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,258.75 | $4,112.00 | $12,670.49 | |
BCBS
| Facility | $10,011.82 | $11,750.93 | $15,920.64 | |
Health Alliance Plan
| Facility | $986.81 | $4,112.00 | $12,670.49 | |
United
| Facility | $4,561.00 | $9,143.00 | $12,767.00 |