| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $570.00 | $1,140.00 | $2,280.00 | |
Aetna
| Professional | $570.00 | $912.00 | $912.00 | |
Molina
| Professional | $1,178.00 | $1,238.80 | $1,238.80 | |
Providence
| Facility | $760.00 | $760.00 | $760.00 | |
Providence
| Professional | $801.80 | $919.60 | $1,056.40 | |
United
| Professional | $319.20 | $319.20 | $456.00 |