| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $303.55 | $303.55 | $303.55 | |
Aetna
| Professional | $300.37 | $336.90 | $435.37 | |
Molina
| Professional | $85.00 | $1,500.00 | $1,500.00 | |
Providence
| Facility | $378.05 | $446.98 | $520.46 |