| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $137.93 | $137.93 | $137.93 | |
Cigna
| Facility | $137.93 | $137.93 | $137.93 | |
Cigna
| Professional | $137.93 | $137.93 | $137.93 | |
United
| Professional | $137.93 | $137.93 | $298.94 |