| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $415.94 | $415.94 | $415.94 | |
MVP Health Care
| Facility | $415.94 | $415.94 | $415.94 | |
MVP Health Care
| Professional | $161.53 | $161.53 | $161.53 | |
United
| Professional | $108.55 | $248.51 | $574.16 |