| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $2,415.69 | $2,415.69 | $2,415.69 | |
Cigna
| Facility | $405.00 | $405.00 | $405.00 | |
Cigna
| Professional | $405.00 | $405.00 | $417.15 | |
Providence
| Facility | $405.00 | $405.00 | $405.00 | |
Providence
| Professional | $405.00 | $405.00 | $417.15 |