| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $109.85 | $109.85 | $109.85 | |
Aetna
| Professional | $75.45 | $79.28 | $79.28 | |
Cigna
| Facility | $62.09 | $62.09 | $62.09 | |
Cigna
| Professional | $57.90 | $109.86 | $150.68 | |
United
| Professional | $38.85 | $53.28 | $110.99 |