| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $117.53 | $117.53 | $117.53 | |
Aetna
| Professional | $117.53 | $117.53 | $117.53 | |
Cigna
| Professional | $120.36 | $120.36 | $120.36 | |
United
| Professional | $118.00 | $118.00 | $118.00 |