| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $404.13 | $404.13 | $404.13 | |
Cigna
| Professional | $104.51 | $104.51 | $104.51 | |
Providence
| Facility | $625.00 | $625.00 | $625.00 | |
Providence
| Professional | $104.51 | $104.51 | $2,250,000.00 |