| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $58.28 | $58.28 | $58.28 | |
Aetna
| Professional | $58.28 | $58.28 | $109.40 | |
Cigna
| Facility | $117.06 | $117.06 | $117.06 | |
Cigna
| Professional | $114.90 | $114.90 | $114.90 | |
United
| Professional | $137.36 | $137.36 | $137.36 |