| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $216.90 | $219.07 | $262.26 | |
Cigna
| Facility | $260.00 | $260.00 | $260.00 | |
Cigna
| Professional | $216.90 | $216.90 | $260.00 | |
Providence
| Facility | $216.90 | $244.93 | $265.14 | |
Providence
| Professional | $216.90 | $257.98 | $276.25 | |
United
| Professional | $216.90 | $216.90 | $216.90 |