| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $103.63 | $166.36 | $274.00 | |
Molina
| Professional | $719.00 | $719.00 | $719.00 | |
Providence
| Facility | $142.44 | $142.44 | $142.44 | |
Providence
| Professional | $29.11 | $82.40 | $144.41 |