| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $255.20 | $255.20 | $255.20 | |
Aetna
| Professional | $255.20 | $269.77 | $321.82 | |
Cigna
| Professional | $22.70 | $22.70 | $22.70 | |
MVP Health Care
| Professional | $22.70 | $22.70 | $22.70 | |
United
| Professional | $258.47 | $258.47 | $258.47 |