| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $12.99 | $12.99 | $12.99 | |
Aetna
| Professional | $12.49 | $12.49 | $12.99 | |
Cigna
| Facility | $11.78 | $12.49 | $12.49 | |
Cigna
| Professional | $12.49 | $12.49 | $12.49 | |
United
| Professional | $12.49 | $12.49 | $12.49 |