| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $85.61 | $85.61 | $85.61 | |
Aetna
| Professional | $68.48 | $68.48 | $68.48 | |
Molina
| Professional | $50.00 | $85.00 | $1,000.00 | |
Providence
| Professional | $324.00 | $324.00 | $324.00 | |
United
| Professional | $77.95 | $110.15 | $170.64 |