| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,673.00 | $7,182.00 | $16,467.00 | |
Aetna
| Professional | $7,182.00 | $7,182.00 | $9,062.00 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 | |
United
| Facility | $2,155.00 | $12,798.00 | $19,665.00 |