| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $657.00 | $2,410.00 | $7,513.00 | |
Aetna
| Professional | $896.00 | $2,901.00 | $12,040.00 | |
United
| Facility | $161.00 | $952.00 | $2,405.00 | |
Wellpoint
| Professional | $159.13 | $159.13 | $214.84 |