| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1.00 | $1.00 | $1.00 | |
Aetna
| Professional | $1.00 | $1.00 | $1.00 | |
Medcost
| Facility | $1.32 | $1.48 | $3.16 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 | |
United
| Professional | $3.09 | $3.09 | $3.09 |