| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $316.23 | $316.23 | $446.68 | |
Cigna
| Facility | $316.23 | $316.23 | $316.23 | |
Cigna
| Professional | $316.23 | $316.23 | $316.23 | |
United
| Professional | $125.89 | $1,148.15 | $1,445.44 |