| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $123.00 | $130.69 | $130.69 | |
Cigna
| Facility | $130.69 | $130.69 | $130.69 | |
Cigna
| Professional | $130.69 | $130.69 | $130.69 | |
United
| Professional | $123.00 | $128.13 | $207.67 |