| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $123.80 | $123.80 | $125.04 | |
Cigna
| Facility | $123.80 | $123.80 | $123.80 | |
Cigna
| Professional | $123.80 | $123.80 | $123.80 | |
United
| Professional | $99.04 | $123.80 | $263.20 |