| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $15.05 | $21.83 | $25.99 | |
Cigna
| Facility | $25.17 | $25.17 | $29.37 | |
Cigna
| Professional | $21.39 | $21.39 | $25.17 | |
United
| Professional | $13.16 | $19.73 | $31.23 |
Regulator (Special Coverage Instructions Apply. See Cim: 60-4 And Mcm: 4107.9)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $15.05 | $21.83 | $25.99 | |
Cigna
| Facility | $25.17 | $25.17 | $29.37 | |
Cigna
| Professional | $21.39 | $21.39 | $25.17 | |
United
| Professional | $13.16 | $19.73 | $31.23 |