| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $758.58 | $4,897.79 | $4,897.79 | |
BCBS
| Facility | $891.25 | $891.25 | $891.25 | |
Health Alliance Plan
| Facility | $758.58 | $1,905.46 | $4,897.79 | |
United
| Facility | $4,677.35 | $8,709.64 | $12,882.50 |