| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $131.83 | $131.83 | $131.83 | |
Aetna
| Professional | $131.83 | $131.83 | $158.49 | |
Cigna
| Facility | $131.83 | $131.83 | $131.83 | |
Cigna
| Professional | $131.83 | $131.83 | $131.83 | |
United
| Facility | $134.90 | $134.90 | $457.09 | |
United
| Professional | $120.23 | $144.54 | $371.54 |