| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $8,912.51 | $9,772.37 | $10,715.19 | |
Aetna
| Facility | 50 | $12,882.50 | $12,882.50 | $12,882.50 |
BCBS
| Facility | $6,165.95 | $6,165.95 | $6,165.95 | |
United
| Facility | $6,165.95 | $6,918.31 | $25,703.96 |