| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $167.65 | $178.13 | $178.13 | |
Cigna
| Facility | $178.13 | $178.13 | $178.13 | |
Cigna
| Professional | $178.13 | $178.13 | $178.13 | |
United
| Professional | $172.47 | $202.90 | $304.35 |