| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $422.90 | $422.90 | $422.90 | |
Cigna
| Facility | $150.00 | $150.00 | $150.00 | |
Cigna
| Professional | $54.43 | $150.00 | $795.12 | |
Providence
| Facility | $50.38 | $150.00 | $646.16 | |
Providence
| Professional | $54.43 | $150.00 | $795.12 | |
United
| Professional | $258.22 | $275.00 | $458.34 |