| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $112.50 | $225.00 | $450.00 | |
Aetna
| Professional | $112.50 | $180.00 | $180.00 | |
Cigna
| Facility | $97.50 | $97.50 | $97.50 | |
Molina
| Professional | $232.50 | $244.50 | $244.50 | |
Providence
| Facility | $97.50 | $150.00 | $189.00 | |
Providence
| Professional | $158.25 | $181.50 | $208.50 | |
United
| Professional | $63.00 | $63.00 | $90.00 |