| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $7.86 | $7.86 | $7.86 | |
Cigna
| Facility | $12.09 | $12.09 | $12.09 | |
Cigna
| Professional | $3.79 | $3.79 | $12.09 | |
Providence
| Facility | $12.09 | $12.09 | $12.09 | |
Providence
| Professional | $3.79 | $10.93 | $14.46 | |
United
| Professional | $3.79 | $3.79 | $3.79 |