| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $338.84 | $4,897.79 | $4,897.79 | |
BCBS
| Facility | $389.05 | $389.05 | $389.05 | |
Health Alliance Plan
| Facility | $338.84 | $812.83 | $4,897.79 | |
United
| Facility | $1,230.27 | $3,890.45 | $6,025.60 |