| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3.98 | $3.98 | $3.98 | |
Aetna
| Professional | $1.00 | $1.00 | $2.00 | |
Molina
| Professional | $4.17 | $4.17 | $6.31 | |
Providence
| Facility | $1.78 | $1.78 | $5.13 | |
United
| Facility | $1.66 | $1.66 | $1.66 | |
United
| Professional | $4.17 | $4.17 | $4.17 |