| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $325.31 | $325.31 | $325.31 | |
Cigna
| Facility | $410.18 | $410.18 | $410.18 | |
Cigna
| Professional | $410.18 | $410.18 | $410.18 | |
Providence
| Facility | $410.18 | $410.18 | $410.18 | |
Providence
| Professional | $254.59 | $254.59 | $410.18 | |
United
| Professional | $118.81 | $118.81 | $282.88 |