| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,089.30 | $2,398.83 | $63,095.73 | |
Aetna
| Professional | $2,089.30 | $2,398.83 | $2,398.83 | |
Molina
| Professional | $39.81 | $39.81 | $50.12 | |
Wellpoint
| Professional | $109.65 | $109.65 | $109.65 |