| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $407.38 | $407.38 | $407.38 | |
Cigna
| Professional | $104.71 | $104.71 | $104.71 | |
Providence
| Facility | $281.84 | $407.38 | $630.96 | |
Providence
| Professional | $35.48 | $35.48 | $100.00 |