| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $853.61 | $853.61 | $853.61 | |
Cigna
| Facility | $1,102.00 | $1,102.00 | $1,102.00 | |
Cigna
| Professional | $1,102.00 | $1,102.00 | $1,102.00 | |
Providence
| Facility | $1,102.00 | $1,102.00 | $1,102.00 | |
Providence
| Professional | $912.00 | $950.00 | $1,102.00 | |
United
| Professional | $319.20 | $319.20 | $760.00 |