| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $212.98 | $212.98 | $212.98 | |
Cigna
| Facility | $268.54 | $268.54 | $268.54 | |
Cigna
| Professional | $268.54 | $268.54 | $268.54 | |
Providence
| Facility | $268.54 | $268.54 | $268.54 | |
Providence
| Professional | $166.68 | $166.68 | $268.54 | |
United
| Professional | $77.78 | $77.78 | $185.20 |