| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $164.02 | $164.02 | $164.02 | |
Cigna
| Facility | $206.81 | $206.81 | $206.81 | |
Cigna
| Professional | $206.81 | $206.81 | $206.81 | |
Providence
| Facility | $206.81 | $206.81 | $206.81 | |
Providence
| Professional | $128.37 | $128.37 | $206.81 | |
United
| Professional | $59.90 | $59.90 | $142.63 |