| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $163.24 | $163.24 | $163.24 | |
Cigna
| Facility | $179.39 | $179.39 | $179.39 | |
Cigna
| Professional | $179.39 | $179.39 | $179.39 | |
United
| Professional | $164.98 | $164.98 | $192.05 |