| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $39.81 | $39.81 | $39.81 | |
Aetna
| Professional | $39.81 | $39.81 | $39.81 | |
Molina
| Professional | $50.12 | $60.26 | $70.79 | |
Providence
| Facility | $39.81 | $39.81 | $64.57 | |
Providence
| Professional | $39.81 | $39.81 | $39.81 |