| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,737.80 | $1,737.80 | $1,737.80 | |
Aetna
| Professional | $467.74 | $549.54 | $1,348.96 | |
Molina
| Professional | $39.81 | $39.81 | $39.81 | |
United
| Facility | $707.95 | $707.95 | $707.95 | |
United
| Professional | $302.00 | $426.58 | $1,202.26 |