| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $6,932.50 | $6,932.50 | $6,932.50 | |
Medcost
| Facility | $6,932.50 | $6,932.50 | $8,319.00 | |
Medcost
| Professional | $6,932.50 | $6,932.50 | $6,932.50 | |
Molina
| Professional | $30.00 | $2,174.68 | $4,714.85 |