| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $4,500.00 | $4,500.00 | $4,500.00 | |
Molina
| Professional | $3,895.54 | $3,895.54 | $4,096.60 | |
Providence
| Professional | $2,651.48 | $2,651.48 | $5,940.00 | |
United
| Professional | $1,055.57 | $1,055.57 | $1,507.95 |