| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $56.22 | $56.22 | $56.22 | |
Cigna
| Facility | $56.50 | $56.50 | $193.57 | |
Cigna
| Professional | $56.50 | $58.20 | $189.81 | |
Providence
| Facility | $56.50 | $117.74 | $193.57 | |
Providence
| Professional | $56.50 | $175.19 | $227.43 | |
United
| Professional | $73.40 | $78.17 | $116.39 |