| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $118.42 | $118.42 | $141.47 | |
Cigna
| Facility | $225.30 | $225.30 | $225.30 | |
Cigna
| Professional | $164.47 | $164.47 | $225.30 | |
United
| Professional | $129.61 | $143.54 | $216.23 |