| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $27.78 | $27.78 | $27.78 | |
Aetna
| Professional | $27.78 | $27.78 | $65.91 | |
Cigna
| Professional | $36.96 | $36.96 | $36.96 | |
Molina
| Professional | $43.27 | $60.00 | $85.00 | |
Providence
| Facility | $23.61 | $23.61 | $23.61 | |
Providence
| Professional | $36.96 | $36.96 | $36.96 |