| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $761.97 | $761.97 | $761.97 | |
Cigna
| Facility | $960.74 | $960.74 | $960.74 | |
Cigna
| Professional | $761.16 | $951.45 | $960.74 | |
Providence
| Facility | $960.74 | $960.74 | $960.74 | |
Providence
| Professional | $662.58 | $795.10 | $960.74 | |
United
| Professional | $278.27 | $278.27 | $662.58 |