| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $125.50 | $125.50 | $125.50 | |
Aetna
| Professional | $125.50 | $125.50 | $125.50 | |
Cigna
| Professional | $137.94 | $137.94 | $137.94 | |
United
| Professional | $147.65 | $166.84 | $177.18 |