| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1.91 | $1.91 | $1.91 | |
Aetna
| Professional | $154.88 | $194.98 | $363.08 | |
Aetna
| Professional | 50 | $831.76 | $831.76 | $831.76 |
Cigna
| Professional | $123.03 | $234.42 | $380.19 | |
United
| Professional | $165.96 | $223.87 | $645.65 |