| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $687.60 | $687.60 | $687.60 | |
Cigna
| Facility | $866.97 | $866.97 | $866.97 | |
Cigna
| Professional | $866.97 | $866.97 | $866.97 | |
Providence
| Facility | $866.97 | $866.97 | $866.97 | |
Providence
| Professional | $538.12 | $538.12 | $866.97 | |
United
| Professional | $251.12 | $251.12 | $597.91 |