| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $45.97 | $45.97 | $45.97 | |
Aetna
| Professional | $35.10 | $45.97 | $60.91 | |
Molina
| Professional | $49.47 | $60.00 | $85.00 | |
Providence
| Facility | $24.74 | $38.26 | $57.17 | |
United
| Professional | $62.03 | $82.01 | $120.02 |