| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $64.57 | $64.57 | $64.57 | |
DeanCare
| Facility | $0.02 | $0.02 | $0.02 | |
Medica
| Facility | $0.02 | $0.02 | $0.02 | |
Molina
| Professional | $32.36 | $54.95 | $87.10 | |
Quartz
| Facility | $64.57 | $64.57 | $64.57 |