| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $548.86 | $548.86 | $548.86 | |
CareSource
| Facility | $66.51 | $66.51 | $86.22 | |
CareSource
| Professional | $66.51 | $79.81 | $99.77 | |
United
| Professional | $4,800.00 | $4,800.00 | $5,140.80 |