| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Professional | $32.36 | $33.11 | $134.90 | |
United
| Professional | $85.11 | $107.15 | $151.36 | |
United
| Professional | 26 | $22.39 | $26.30 | $34.67 |
United
| Professional | TC | $66.07 | $85.11 | $112.20 |