| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $66.90 | $66.90 | $72.43 | |
Cigna
| Facility | $94.12 | $94.12 | $94.12 | |
Cigna
| Professional | $49.22 | $94.12 | $94.12 | |
Providence
| Facility | $49.22 | $94.12 | $94.12 | |
Providence
| Professional | $57.91 | $94.12 | $112.56 | |
United
| Professional | $16.22 | $16.22 | $16.22 |