| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,908.26 | $1,908.26 | $1,908.26 | |
Aetna
| Professional | $1,908.26 | $1,908.26 | $1,908.26 | |
Providence
| Facility | $1,908.26 | $1,908.26 | $2,501.75 | |
Providence
| Professional | $2,501.75 | $2,501.75 | $2,501.75 |