| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $128.16 | $128.16 | $128.16 | |
Aetna
| Professional | $126.81 | $132.00 | $142.29 | |
Molina
| Professional | $60.00 | $60.00 | $1,500.00 | |
Providence
| Facility | $114.98 | $135.93 | $167.77 |