| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.20 | $50.12 | $50.12 | |
Aetna
| Professional | $30.20 | $50.12 | $50.12 | |
Molina
| Professional | $32.36 | $39.81 | $50.12 | |
United
| Professional | $34.67 | $39.81 | $60.26 | |
Wellpoint
| Professional | $169.82 | $169.82 | $169.82 |