| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,747.00 | $9,338.46 | $30,593.00 | |
Aetna
| Professional | $7,074.00 | $7,074.00 | $20,400.00 | |
Pacific Source
| Facility | $35,917.69 | $39,325.94 | $67,897.86 | |
United
| Facility | $4,252.00 | $37,152.00 | $65,339.00 |