| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $172.40 | $172.40 | $172.40 | |
Aetna
| Professional | $172.40 | $172.40 | $172.40 | |
Cigna
| Facility | $172.40 | $172.40 | $172.40 | |
Cigna
| Professional | $172.40 | $172.40 | $250.09 | |
United
| Professional | $202.82 | $202.82 | $293.74 |