| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,630.78 | $8,511.38 | $10,000.00 | |
Aetna
| Professional | $5,128.61 | $5,128.61 | $5,128.61 | |
Cigna
| Professional | $3,467.37 | $3,467.37 | $3,467.37 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |