| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $316.05 | $316.05 | $316.05 | |
Cigna
| Facility | $398.50 | $398.50 | $398.50 | |
Cigna
| Professional | $398.50 | $398.50 | $398.50 | |
Providence
| Facility | $398.50 | $398.50 | $398.50 | |
Providence
| Professional | $247.35 | $247.35 | $398.50 | |
United
| Professional | $103.54 | $103.54 | $246.52 |