| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $36.34 | $36.34 | $36.34 | |
Cigna
| Facility | $1,100.61 | $1,100.61 | $1,425.00 | |
Cigna
| Professional | $1,100.61 | $1,100.61 | $1,100.61 | |
Providence
| Facility | $1,100.61 | $1,100.61 | $1,425.00 | |
Providence
| Professional | $910.86 | $948.81 | $1,100.61 | |
United
| Professional | $318.80 | $318.80 | $759.05 |