| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $201.03 | $201.03 | $201.03 | |
Cigna
| Facility | $253.47 | $253.47 | $253.47 | |
Cigna
| Professional | $253.47 | $253.47 | $253.47 | |
Providence
| Facility | $253.47 | $253.47 | $253.47 | |
Providence
| Professional | $157.33 | $157.33 | $253.47 | |
United
| Facility | $209.77 | $209.77 | $209.77 | |
United
| Professional | $73.42 | $73.42 | $174.81 |