| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $96.32 | $96.32 | $96.32 | |
Cigna
| Facility | $121.45 | $121.45 | $121.45 | |
Cigna
| Professional | $96.23 | $120.29 | $121.45 | |
Providence
| Facility | $121.45 | $121.45 | $121.45 | |
Providence
| Professional | $75.38 | $83.76 | $104.70 | |
United
| Professional | $35.18 | $35.18 | $83.76 |