| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $112.26 | $121.16 | $128.94 | |
Cigna
| Facility | $379.47 | $379.47 | $379.47 | |
Cigna
| Professional | $111.15 | $379.47 | $379.47 | |
Providence
| Facility | $111.15 | $379.47 | $440.31 | |
Providence
| Professional | $120.59 | $120.59 | $440.31 | |
United
| Professional | $111.15 | $111.15 | $111.15 |