| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $57.67 | $57.67 | $57.67 | |
Providence
| Facility | $57.67 | $57.67 | $57.67 | |
Providence
| Professional | $1,800,000.00 | $2,250,000.00 | $2,400,000.00 | |
United
| Professional | $62.92 | $62.92 | $62.92 |