| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $180.21 | $180.21 | $180.21 | |
Cigna
| Facility | $290.77 | $290.77 | $290.77 | |
Cigna
| Professional | $290.77 | $290.77 | $290.77 | |
Providence
| Facility | $290.77 | $290.77 | $290.77 | |
Providence
| Professional | $185.37 | $262.61 | $347.10 | |
United
| Professional | $268.83 | $331.76 | $366.07 |