| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $20.00 | $20.00 | $128.86 | |
Cigna
| Professional | $73.00 | $73.00 | $87.00 | |
Molina
| Professional | $50.00 | $60.00 | $1,500.00 | |
Providence
| Facility | $20.00 | $20.00 | $114.00 | |
Providence
| Professional | $73.00 | $73.00 | $87.00 |