| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $29.48 | $29.48 | $29.48 | |
Cigna
| Facility | $45.74 | $45.74 | $45.74 | |
Cigna
| Professional | $45.74 | $45.74 | $45.74 | |
Providence
| Facility | $45.74 | $45.74 | $45.74 | |
Providence
| Professional | $15.51 | $45.74 | $62.14 | |
United
| Facility | $200.00 | $200.00 | $200.00 | |
United
| Professional | $41.89 | $47.52 | $53.97 |