| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $247.40 | $247.40 | $247.40 | |
Cigna
| Facility | $170.83 | $170.83 | $170.83 | |
Cigna
| Professional | $170.83 | $170.83 | $170.83 | |
Providence
| Facility | $170.83 | $247.40 | $247.40 | |
Providence
| Professional | $170.83 | $170.83 | $170.83 |