| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $231.06 | $231.06 | $231.06 | |
Aetna
| Professional | $228.64 | $256.44 | $355.78 | |
Molina
| Professional | $85.00 | $234.92 | $1,500.00 | |
Providence
| Facility | $309.04 | $379.36 | $474.23 |