| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $867.73 | $4,933.00 | $4,933.00 | |
BCBS
| Facility | $3,337.28 | $3,889.72 | $5,269.95 | |
Health Alliance Plan
| Facility | $721.87 | $4,933.00 | $4,933.00 | |
United
| Facility | $5,000.00 | $10,359.00 | $12,767.00 |