| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,528.00 | $2,747.00 | $6,084.00 | |
Aetna
| Professional | $1,395.28 | $1,395.28 | $1,395.28 | |
United
| Facility | $3,028.00 | $3,028.00 | $3,028.00 | |
United
| Professional | $644.92 | $1,769.87 | $1,911.80 |