| 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 | $27,179.94 | $29,759.06 | $51,380.26 | |
United
| Facility | $3,340.00 | $26,100.00 | $49,245.00 |