| 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 | $3.02 | |
BCBS
| Professional | $5.50 | $5.50 | $5.50 | |
Molina
| Professional | $5.50 | $5.50 | $5.50 | |
Providence
| Facility | $1.12 | $1.12 | $1.12 | |
Providence
| Professional | $1.12 | $1.74 | $1.74 |