| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $19.95 | $19.95 | $19.95 | |
Aetna
| Professional | $19.05 | $19.05 | $19.95 | |
Cigna
| Facility | $85.11 | $85.11 | $85.11 | |
Cigna
| Professional | $107.15 | $107.15 | $107.15 | |
United
| Facility | $10.23 | $10.23 | $10.23 |