| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $7.50 | $7.50 | $7.50 | |
Aetna
| Professional | $7.50 | $7.50 | $7.50 | |
Cigna
| Professional | $3.96 | $4.37 | $4.37 | |
Molina
| Professional | $10.00 | $10.18 | $1,500.00 | |
Providence
| Facility | $7.50 | $7.50 | $7.50 | |
Providence
| Professional | $4.37 | $4.37 | $4.37 |