| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $171.15 | $171.15 | $171.15 | |
Aetna
| Professional | $171.15 | $171.15 | $289.19 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $204.84 | $204.84 | $204.84 | |
United
| Professional | $699.93 | $699.93 | $699.93 |