| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $59.28 | $59.28 | $59.28 | |
Cigna
| Facility | $526.69 | $526.69 | $526.69 | |
Cigna
| Professional | $526.69 | $526.69 | $526.69 | |
Providence
| Facility | $59.28 | $59.28 | $526.69 | |
Providence
| Professional | $526.69 | $526.69 | $526.69 |