| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $89.13 | $89.13 | $89.13 | |
Cigna
| Professional | $91.20 | $91.20 | $91.20 | |
Providence
| Facility | $89.13 | $100.00 | $169.82 | |
Providence
| Professional | $60.26 | $79.43 | $85.11 |