| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $503.29 | $503.29 | $503.29 | |
Cigna
| Facility | $390.00 | $390.00 | $390.00 | |
Cigna
| Professional | $390.00 | $390.00 | $390.00 | |
Providence
| Facility | $295.62 | $503.29 | $569.60 | |
Providence
| Professional | $390.00 | $390.00 | $390.00 |