| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $28.87 | $28.87 | $28.87 | |
Cigna
| Facility | $36.40 | $36.40 | $36.40 | |
Cigna
| Professional | $36.40 | $36.40 | $36.40 | |
Providence
| Facility | $18.82 | $25.10 | $40.15 | |
Providence
| Professional | $22.59 | $27.61 | $36.40 | |
United
| Professional | $10.54 | $10.54 | $25.10 |