| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,677.35 | $11,481.54 | $28,183.83 | |
Aetna
| Professional | $1,412.54 | $3,801.89 | $28,183.83 | |
Molina
| Professional | $48.98 | $50.12 | $75.86 | |
United
| Facility | $707.95 | $2,454.71 | $37,153.52 |