| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $114.56 | $114.56 | $114.56 | |
Aetna
| Professional | $92.13 | $113.35 | $127.20 | |
Molina
| Professional | $60.00 | $85.00 | $1,500.00 | |
Providence
| Facility | $80.13 | $100.01 | $116.54 |