| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $120.23 | $120.23 | $120.23 | |
Aetna
| Professional | $114.82 | $120.23 | $123.03 | |
Molina
| Professional | $30.20 | $61.66 | $75.86 | |
Select Health
| Professional | $104.71 | $144.54 | $144.54 |