| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $111.15 | $111.15 | $111.15 | |
Cigna
| Facility | $104.86 | $376.33 | $627.21 | |
Cigna
| Professional | $111.15 | $111.15 | $627.21 | |
MVP Health Care
| Facility | $104.86 | $376.33 | $627.21 | |
MVP Health Care
| Professional | $111.15 | $111.15 | $627.21 | |
United
| Professional | $111.15 | $111.15 | $333.45 |