| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $149.83 | $149.83 | $149.83 | |
Aetna
| Professional | $149.83 | $149.83 | $149.83 | |
Cigna
| Professional | $164.66 | $164.66 | $164.66 | |
United
| Professional | $139.66 | $166.13 | $176.42 |