| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $269.15 | $269.15 | $269.15 | |
Aetna
| Professional | $104.71 | $104.71 | $144.54 | |
Cigna
| Facility | $141.25 | $141.25 | $141.25 | |
Cigna
| Professional | $104.71 | $104.71 | $104.71 | |
United
| Professional | $104.71 | $109.65 | $154.88 |