| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $518.54 | $518.54 | $518.54 | |
Cigna
| Facility | $653.82 | $653.82 | $653.82 | |
Cigna
| Professional | $653.82 | $653.82 | $653.82 | |
Providence
| Facility | $653.82 | $653.82 | $653.82 | |
Providence
| Professional | $405.82 | $405.82 | $653.82 | |
United
| Professional | $189.38 | $189.38 | $450.91 |