| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,826.25 | $3,652.50 | $7,305.00 | |
Aetna
| Professional | $1,826.25 | $2,922.00 | $2,922.00 | |
Molina
| Professional | $3,774.25 | $3,969.05 | $3,969.05 | |
Providence
| Facility | $3,068.10 | $3,068.10 | $3,068.10 | |
Providence
| Professional | $2,568.92 | $2,568.92 | $2,922.00 | |
United
| Professional | $1,022.70 | $1,022.70 | $1,461.00 |