| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $87.54 | $87.54 | $87.54 | |
Aetna
| Professional | $87.54 | $136.69 | $136.69 | |
Cigna
| Facility | $128.69 | $128.69 | $232.02 | |
Cigna
| Professional | $128.69 | $128.69 | $729.65 | |
United
| Professional | $259.31 | $259.31 | $375.56 |