| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $87.45 | $969.54 | $4,933.00 | |
Aetna
| Facility | 52 | $42.11 | $43.73 | $77.91 |
BCBS
| Facility | $497.81 | $704.74 | $1,663.58 | |
Health Alliance Plan
| Facility | $110.19 | $979.00 | $2,912.44 | |
Health Alliance Plan
| Facility | 52 | $42.11 | $42.11 | $75.02 |
United
| Facility | $464.00 | $1,247.00 | $1,844.00 |