| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $112.20 | $112.20 | $173.78 | |
Cigna
| Facility | $112.20 | $112.20 | $112.20 | |
Cigna
| Professional | $112.20 | $112.20 | $112.20 | |
United
| Professional | $125.89 | $645.65 | $870.96 |