| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $242.00 | $242.00 | $242.00 | |
Aetna
| Professional | $239.46 | $264.25 | $268.56 | |
Molina
| Professional | $60.00 | $60.00 | $1,500.00 | |
Providence
| Facility | $228.91 | $294.31 | $367.23 |