| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $131.90 | $131.90 | $131.90 | |
Aetna
| Professional | $131.90 | $131.90 | $145.09 | |
Cigna
| Facility | $131.90 | $131.90 | $131.90 | |
Cigna
| Professional | $131.90 | $131.90 | $472.08 | |
United
| Professional | $114.75 | $131.90 | $131.90 |