| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,412.54 | $4,677.35 | $22,908.68 | |
Aetna
| Facility | 22 | $15,848.93 | $15,848.93 | $15,848.93 |
Anthem BCBS
| Facility | $9,332.54 | $10,471.29 | $19,952.62 | |
Harvard Pilgrim
| Facility | $12,302.69 | $12,302.69 | $12,302.69 | |
United
| Facility | $12,302.69 | $12,302.69 | $12,302.69 |