| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $138.72 | $3,374.00 | $9,842.00 | |
Aetna
| Facility | 50 | $1,033.50 | $2,067.00 | $6,073.00 |
Aetna
| Professional | 50 | $170.28 | $427.23 | $897.15 |
Ambetter
| Professional | 50 | $173.76 | $173.76 | $249.65 |
United
| Facility | $1,516.00 | $3,352.00 | $10,536.00 |