| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $366.15 | $366.15 | $366.15 | |
Aetna
| Professional | $366.15 | $366.15 | $366.15 | |
Cigna
| Professional | $374.98 | $374.98 | $374.98 | |
United
| Professional | $349.25 | $367.63 | $367.63 |