| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $292.62 | $2,647.00 | $4,773.68 | |
Aetna
| Facility | 52 | $146.32 | $146.32 | $146.32 |
BCBS
| Facility | $2,273.67 | $2,699.71 | $3,707.99 | |
Health Alliance Plan
| Facility | $297.89 | $2,877.00 | $4,933.00 | |
Health Alliance Plan
| Facility | 52 | $146.32 | $146.32 | $146.32 |
United
| Facility | $1,050.00 | $4,857.00 | $6,036.00 |