| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $220.80 | $220.80 | $220.80 | |
Cigna
| Facility | $556.79 | $556.79 | $556.79 | |
Cigna
| Professional | $556.79 | $556.79 | $556.79 | |
Providence
| Facility | $556.79 | $556.79 | $556.79 | |
Providence
| Professional | $172.80 | $172.80 | $480.00 | |
United
| Professional | $80.64 | $80.64 | $192.00 |