| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $2,960.85 | $2,960.85 | $2,960.85 | |
Cigna
| Facility | $604.33 | $604.33 | $604.33 | |
Cigna
| Professional | $604.33 | $604.33 | $604.33 | |
Providence
| Facility | $604.33 | $604.33 | $604.33 | |
Providence
| Professional | $500.14 | $520.98 | $604.33 | |
United
| Professional | $175.05 | $175.05 | $416.78 |