| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $154.25 | $154.25 | $154.25 | |
Cigna
| Facility | $194.49 | $194.49 | $194.49 | |
Cigna
| Professional | $194.49 | $194.49 | $194.49 | |
Providence
| Facility | $194.49 | $194.49 | $194.49 | |
Providence
| Professional | $120.72 | $120.72 | $194.49 | |
United
| Professional | $56.33 | $56.33 | $134.13 |