| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $134.88 | $134.88 | $134.88 | |
Cigna
| Facility | $134.88 | $134.88 | $134.88 | |
Cigna
| Professional | $134.88 | $134.88 | $134.88 | |
United
| Professional | $114.66 | $134.88 | $218.63 |