| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $159.36 | $159.36 | $159.36 | |
Cigna
| Professional | $163.19 | $163.19 | $163.19 | |
Providence
| Professional | $163.19 | $163.19 | $192.00 | |
United
| Professional | $160.00 | $160.00 | $160.00 |