| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $217.46 | $217.46 | $217.46 | |
Aetna
| Professional | $215.19 | $241.35 | $269.10 | |
Molina
| Professional | $60.00 | $60.00 | $1,500.00 | |
Providence
| Facility | $233.80 | $276.49 | $334.08 |