| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $104.83 | $104.83 | $104.83 | |
Aetna
| Professional | $72.02 | $75.66 | $75.66 | |
Cigna
| Facility | $59.25 | $59.25 | $59.25 | |
Cigna
| Professional | $64.11 | $104.90 | $175.72 | |
United
| Professional | $38.29 | $54.70 | $127.36 |