| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $200.00 | $200.00 | $200.00 | |
Aetna
| Professional | $2,687.00 | $2,687.00 | $2,687.00 | |
Medica
| Facility | $1,027.46 | $1,027.46 | $1,027.46 | |
Molina
| Professional | $50.00 | $65.00 | $85.00 |