| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $539.01 | $599.01 | $599.01 | |
Aetna
| Professional | $148.16 | $148.16 | $155.29 | |
Medcost
| Facility | $148.16 | $149.66 | $287.29 | |
Medcost
| Professional | $571.47 | $571.47 | $571.47 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 | |
United
| Professional | $155.26 | $209.69 | $382.12 |