| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $164.60 | $164.60 | $164.60 | |
Aetna
| Professional | $164.60 | $164.60 | $189.28 | |
Cigna
| Professional | $175.41 | $175.41 | $175.41 | |
United
| Professional | $148.87 | $177.07 | $188.04 |