| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,434.93 | $1,434.93 | $1,434.93 | |
Aetna
| Professional | $344.00 | $344.00 | $344.00 | |
Molina
| Professional | $50.00 | $50.00 | $50.00 | |
Wellpoint
| Professional | $1.72 | $1.72 | $1.72 |