| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $204.96 | $204.96 | $204.96 | |
Cigna
| Facility | $204.96 | $204.96 | $204.96 | |
Cigna
| Professional | $204.96 | $204.96 | $204.96 | |
United
| Professional | $204.96 | $204.96 | $450.91 |