| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $240.00 | $240.00 | $240.00 | |
United
| Facility | $2,446.00 | $2,446.00 | $2,446.00 | |
United
| Professional | $326.17 | $380.10 | $417.35 | |
University Health Alliance
| Professional | $29.27 | $29.27 | $29.27 |