| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $168.10 | $168.10 | $168.10 | |
Aetna
| Professional | $65.41 | $65.41 | $65.41 | |
Cigna
| Facility | $65.40 | $65.40 | $65.40 | |
Cigna
| Professional | $65.40 | $65.40 | $65.40 | |
United
| Professional | $65.41 | $65.41 | $143.90 |