| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $59.36 | $434.62 | $434.62 | |
Cigna
| Facility | $112.36 | $141.96 | $141.96 | |
Cigna
| Professional | $112.36 | $115.73 | $141.96 | |
Providence
| Facility | $75.38 | $135.19 | $141.96 | |
Providence
| Professional | $106.54 | $112.36 | $155.47 | |
United
| Professional | $60.96 | $67.45 | $81.25 |