| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $28.75 | $28.75 | $28.75 | |
Cigna
| Facility | $36.25 | $36.25 | $36.25 | |
Cigna
| Professional | $36.25 | $36.25 | $36.25 | |
Providence
| Facility | $36.25 | $36.25 | $36.25 | |
Providence
| Professional | $22.50 | $22.50 | $36.25 | |
United
| Professional | $10.50 | $10.50 | $25.00 |