| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,500.00 | $12,214.00 | $27,982.24 | |
Aetna
| Professional | $1,420.00 | $1,420.00 | $27,982.24 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 | |
United
| Facility | $497.00 | $1,078.00 | $6,216.00 |