| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $86.63 | $86.63 | $87.06 | |
Aetna
| Professional | $65.23 | $72.09 | $113.99 | |
Aetna
| Professional | 25 | $209.60 | $209.60 | $245.55 |
Cigna
| Professional | $72.56 | $100.58 | $167.11 | |
MVP Health Care
| Professional | $72.56 | $101.07 | $167.11 | |
United
| Professional | $78.72 | $107.31 | $210.69 |