| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $63.28 | $63.28 | $69.29 | |
Aetna
| Professional | $63.28 | $69.29 | $72.38 | |
Molina
| Professional | $32.34 | $60.00 | $167.78 | |
Providence
| Facility | $63.28 | $69.29 | $76.62 | |
Providence
| Professional | $1,800,000.00 | $1,800,000.00 | $2,250,000.00 |