| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $25.40 | $50.79 | $101.58 | |
Aetna
| Professional | $25.40 | $40.63 | $40.63 | |
Molina
| Professional | $52.48 | $55.19 | $55.19 | |
Providence
| Facility | $33.86 | $33.86 | $42.66 | |
Providence
| Professional | $35.72 | $40.63 | $47.07 | |
United
| Professional | $14.22 | $14.22 | $20.32 |