| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $107.15 | $4,897.79 | $4,897.79 | |
BCBS
| Facility | $77.62 | $123.03 | $123.03 | |
Health Alliance Plan
| Facility | $89.13 | $239.88 | $4,897.79 | |
United
| Facility | $102.33 | $1,202.26 | $2,041.74 |