| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $60.92 | $60.92 | $60.92 | |
Aetna
| Professional | $58.48 | $60.92 | $200.71 | |
Molina
| Professional | $69.56 | $69.56 | $69.56 | |
Providence
| Facility | $34.03 | $45.70 | $79.47 | |
Providence
| Professional | $27.63 | $27.63 | $27.63 | |
United
| Professional | $50.71 | $77.61 | $92.20 |