| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $138.90 | $277.80 | $555.60 | |
Aetna
| Professional | $138.90 | $222.24 | $222.24 | |
Cigna
| Facility | $120.38 | $120.38 | $120.38 | |
Molina
| Professional | $287.06 | $301.88 | $301.88 | |
Providence
| Facility | $120.38 | $185.20 | $233.35 | |
Providence
| Professional | $195.39 | $224.09 | $257.43 | |
United
| Professional | $77.78 | $77.78 | $111.12 |