| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $8.16 | $8.16 | $8.16 | |
Pacific Source
| Facility | $12.10 | $14.53 | $79,999.20 | |
Providence
| Professional | $10.45 | $10.45 | $10.45 | |
United
| Professional | $12.10 | $12.10 | $13.20 |