| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $1,201.00 | $1,201.00 | $1,201.00 | |
Molina
| Professional | $50.00 | $60.00 | $1,500.00 | |
Providence
| Facility | $1,201.00 | $1,201.00 | $1,201.00 | |
United
| Facility | $2,138.63 | $2,138.63 | $2,138.63 |