| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $118.45 | $935.00 | $2,010.00 | |
Aetna
| Facility | 50 | $3,830.13 | $3,830.13 | $3,830.13 |
Ambetter
| Professional | 50 | $145.76 | $145.76 | $300.00 |
United
| Facility | $225.00 | $537.00 | $1,893.00 |