| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $315.97 | $315.97 | $315.97 | |
Cigna
| Facility | $338.00 | $338.00 | $338.00 | |
Cigna
| Professional | $41.13 | $338.00 | $626.88 | |
Providence
| Facility | $36.93 | $207.72 | $473.62 | |
Providence
| Professional | $41.13 | $338.00 | $626.88 | |
United
| Professional | $200.30 | $200.30 | $333.83 |