| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $117.49 | $1,047.13 | $4,466.84 | |
Aetna
| Facility | 50 | $3,801.89 | $3,801.89 | $3,801.89 |
Aetna
| Professional | 50 | $147.91 | $338.84 | $1,348.96 |
United
| Facility | $338.84 | $588.84 | $1,659.59 |