| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $6,008.29 | $6,008.29 | $6,008.29 | |
Cigna
| Facility | $165.92 | $165.92 | $165.92 | |
Cigna
| Professional | $131.75 | $164.68 | $165.92 | |
Providence
| Facility | $165.92 | $165.92 | $165.92 | |
Providence
| Professional | $114.43 | $137.32 | $165.92 | |
United
| Professional | $48.06 | $48.06 | $114.43 |