| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $509.81 | $509.81 | $509.81 | |
Cigna
| Facility | $642.79 | $642.79 | $642.79 | |
Cigna
| Professional | $642.79 | $642.79 | $642.79 | |
Providence
| Facility | $642.79 | $642.79 | $642.79 | |
Providence
| Professional | $531.97 | $531.97 | $642.79 | |
United
| Professional | $186.19 | $186.19 | $443.31 |