| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $57.67 | $57.67 | $57.67 | |
Aetna
| Professional | $57.67 | $57.67 | $57.67 | |
Cigna
| Facility | $117.00 | $117.00 | $117.00 | |
Cigna
| Professional | $0.65 | $0.65 | $0.65 | |
United
| Professional | $62.92 | $73.40 | $136.32 |