| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $225.57 | $225.57 | $225.57 | |
Aetna
| Professional | $216.68 | $216.68 | $225.57 | |
Molina
| Professional | $60.00 | $85.00 | $463.25 | |
United
| Professional | $196.66 | $217.60 | $505.15 |