| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $800.00 | $1,399.00 | $2,250.00 | |
Aetna
| Facility | 53 | $175.25 | $175.25 | $175.25 |
BCBS
| Facility | $11,049.26 | $13,408.80 | $18,039.12 | |
United
| Facility | $4,200.00 | $8,790.00 | $16,472.00 |