| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $40.35 | $40.35 | $40.35 | |
Cigna
| Facility | $50.88 | $50.88 | $50.88 | |
Cigna
| Professional | $50.88 | $50.88 | $50.88 | |
Providence
| Facility | $50.88 | $50.88 | $50.88 | |
Providence
| Professional | $31.58 | $31.58 | $50.88 | |
United
| Professional | $14.74 | $14.74 | $35.09 |