| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $117.27 | $117.27 | $119.85 |
Aetna
| Professional | TC | $290.20 | $448.71 | $755.37 |
Cigna
| Professional | TC | $377.10 | $460.77 | $724.61 |
United
| Professional | TC | $314.38 | $435.71 | $926.57 |