| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $862.50 | $862.50 | $862.50 | |
Cigna
| Facility | $1,087.50 | $1,087.50 | $1,087.50 | |
Cigna
| Professional | $861.93 | $1,077.41 | $1,087.50 | |
Providence
| Facility | $1,087.50 | $1,087.50 | $1,087.50 | |
Providence
| Professional | $675.00 | $675.00 | $1,087.50 | |
United
| Professional | $315.00 | $315.00 | $750.00 |