| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $38.94 | $38.94 | $38.94 | |
Cigna
| Facility | $49.10 | $49.10 | $49.10 | |
Cigna
| Professional | $49.10 | $49.10 | $49.10 | |
Providence
| Facility | $49.10 | $49.10 | $49.10 | |
Providence
| Professional | $30.47 | $30.47 | $49.10 | |
United
| Professional | $14.22 | $14.22 | $33.86 |