| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.80 | $0.80 | $0.80 | |
Aetna
| Professional | $0.80 | $0.80 | $99.00 | |
Molina
| Professional | $6.56 | $6.56 | $60.00 | |
Providence
| Facility | $2.39 | $2.39 | $2.39 | |
Providence
| Professional | $2.39 | $2.39 | $2,400,000.00 |