| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $125.89 | $125.89 | $125.89 | |
Aetna
| Professional | $123.03 | $125.89 | $128.82 | |
Cigna
| Facility | $128.82 | $128.82 | $128.82 | |
United
| Facility | $131.83 | $131.83 | $131.83 | |
United
| Professional | $125.89 | $125.89 | $204.17 |