| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $5,011.87 | $5,011.87 | $5,011.87 | |
Medcost
| Facility | $5,011.87 | $7,244.36 | $8,511.38 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 | |
United
| Professional | $758.58 | $891.25 | $891.25 |