| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,400.00 | $1,400.00 | $1,400.00 | |
CareSource
| Facility | $313.93 | $313.93 | $313.93 | |
CareSource
| Professional | $214.65 | $214.65 | $214.65 | |
United
| Facility | $460.00 | $460.00 | $460.00 |