| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,522.00 | $6,040.31 | $10,492.00 | |
Aetna
| Facility | 50 | $9,634.00 | $9,634.00 | $15,847.50 |
Anthem BCBS
| Facility | $8,873.00 | $9,678.00 | $12,904.00 | |
Health New England
| Facility | $4,873.05 | $4,873.05 | $4,873.05 | |
United
| Facility | $5,325.00 | $8,250.00 | $11,880.00 |