| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $645.65 | $3,467.37 | $4,466.84 | |
Aetna
| Professional | $389.05 | $645.65 | $891.25 | |
Molina
| Professional | $44.67 | $44.67 | $79.43 | |
United
| Professional | $295.12 | $295.12 | $426.58 |