| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,747.00 | $6,072.60 | $15,341.00 | |
Aetna
| Professional | $6,616.00 | $6,616.00 | $20,400.00 | |
Pacific Source
| Facility | $8,501.54 | $9,308.27 | $16,071.11 | |
United
| Facility | $3,028.00 | $20,708.00 | $24,872.00 |