| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,210.89 | $3,079.51 | $15,768.42 | |
Aetna
| Facility | 22 | $7,500.00 | $7,500.00 | $7,500.00 |
BCBS
| Facility | $7,951.23 | $9,649.20 | $12,981.26 | |
United
| Facility | $2,125.00 | $5,085.00 | $9,624.00 |