| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,233.00 | $1,813.00 | $2,843.00 | |
Aetna
| Facility | 54 | $1,124.33 | $1,124.33 | $1,124.33 |
BCBS
| Facility | $2,295.13 | $2,785.25 | $3,747.05 | |
United
| Facility | $834.00 | $2,891.00 | $4,402.00 |