| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $47.86 | $47.86 | $47.86 | |
Pacific Source
| Facility | $37.15 | $37.15 | $37.15 | |
Providence
| Professional | $79.43 | $79.43 | $100.00 | |
United
| Professional | $10.00 | $10.96 | $28.18 |