| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $54.95 | $54.95 | $54.95 | |
Aetna
| Professional | $30.90 | $38.90 | $141.25 | |
Cigna
| Facility | $30.90 | $30.90 | $30.90 | |
Cigna
| Professional | $31.62 | $31.62 | $31.62 | |
United
| Professional | $19.95 | $28.18 | $104.71 |