| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $528.00 | $528.00 | $528.00 | |
Aetna
| Professional | $307.58 | $350.00 | $350.00 | |
United
| Professional | $76.31 | $101.76 | $107.64 | |
Wellpoint
| Professional | $20.00 | $20.00 | $20.00 |