| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,080.00 | $2,374.87 | $2,731.10 | |
Aetna
| Professional | $2,080.00 | $2,374.87 | $2,374.87 | |
Molina
| Professional | $40.00 | $40.00 | $50.00 | |
Wellpoint
| Professional | $109.53 | $109.53 | $109.53 |