| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $129.62 | $129.62 | $137.72 | |
Cigna
| Facility | $137.72 | $137.72 | $137.72 | |
Cigna
| Professional | $137.72 | $137.72 | $137.72 | |
United
| Professional | $153.91 | $153.91 | $153.91 |