| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $640.00 | $640.00 | $640.00 | |
Aetna
| Professional | $640.00 | $640.00 | $1,820.00 | |
Medcost
| Facility | $640.00 | $736.00 | $1,356.80 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |