| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $4,998.68 | $4,998.68 | $4,998.68 | |
Medcost
| Facility | $6,498.28 | $6,498.28 | $6,498.28 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 | |
United
| Professional | $800.04 | $888.93 | $977.82 |