| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $200.00 | $200.00 | $200.00 | |
Aetna
| Professional | $854.03 | $854.03 | $854.03 | |
Anthem BCBS
| Professional | $16.75 | $16.75 | $16.75 | |
Medica
| Facility | $854.03 | $854.03 | $854.03 | |
Molina
| Professional | $50.00 | $50.00 | $70.00 |