| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $125.20 | $125.20 | $125.20 | |
Aetna
| Professional | $55.00 | $125.20 | $125.20 | |
Cigna
| Professional | $201.75 | $201.75 | $201.75 | |
MVP Health Care
| Professional | $201.75 | $201.75 | $201.75 | |
United
| Facility | $233.00 | $233.00 | $233.00 |