| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $60.92 | $200.71 | $200.71 | |
Cigna
| Facility | $73.05 | $73.05 | $73.05 | |
Cigna
| Professional | $73.05 | $73.05 | $73.05 | |
Providence
| Facility | $73.05 | $73.05 | $73.05 | |
Providence
| Professional | $54.83 | $54.83 | $73.05 | |
United
| Professional | $52.00 | $89.75 | $102.57 |