| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $110.01 | $110.01 | $110.01 | |
Aetna
| Professional | $106.12 | $110.01 | $182.94 | |
Cigna
| Professional | $208.51 | $208.51 | $208.51 | |
United
| Professional | $129.41 | $129.41 | $129.41 |