| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,933.00 | $4,933.00 | $4,933.00 | |
BCBS
| Facility | $25,597.21 | $49,192.16 | $96,119.75 | |
Health Alliance Plan
| Facility | $4,933.00 | $4,933.00 | $4,933.00 | |
Health Alliance Plan
| Professional | $4,933.00 | $4,933.00 | $4,933.00 | |
United
| Facility | $9,428.00 | $14,270.00 | $20,603.00 |