| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $56.20 | $56.20 | $56.20 | |
Aetna
| Professional | $56.20 | $67.81 | $67.81 | |
Cigna
| Facility | $49.22 | $49.22 | $49.22 | |
Cigna
| Professional | $49.22 | $49.22 | $49.22 | |
Providence
| Facility | $45.57 | $45.57 | $51.36 | |
Providence
| Professional | $49.22 | $49.22 | $49.22 | |
United
| Professional | $16.22 | $16.22 | $16.22 |