| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $100.00 | $3,602.03 | $27,077.51 | |
Aetna
| Facility | 22 | $4,250.00 | $4,250.00 | $4,250.00 |
Anthem BCBS
| Facility | $8,402.07 | $16,742.15 | $24,290.01 | |
United
| Facility | $9,949.00 | $9,949.00 | $9,949.00 |