| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $22.31 | $22.31 | $22.31 | |
Aetna
| Professional | $22.31 | $22.31 | $22.31 | |
Cigna
| Facility | $174.33 | $174.33 | $236.36 | |
Cigna
| Professional | $174.33 | $174.33 | $988.49 | |
United
| Professional | $117.65 | $205.28 | $318.62 |