| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $41.69 | $41.69 | $41.69 | |
Aetna
| Professional | $41.69 | $41.69 | $41.69 | |
Cigna
| Professional | $31.62 | $31.62 | $31.62 | |
Harvard Pilgrim
| Professional | $41.69 | $74.13 | $102.33 | |
United
| Professional | $37.15 | $39.81 | $64.57 |