| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $52.75 | $52.75 | $52.75 | |
Aetna
| Professional | $52.75 | $52.75 | $58.03 | |
Cigna
| Facility | $52.75 | $52.75 | $52.75 | |
Cigna
| Professional | $52.75 | $52.75 | $78.04 | |
United
| Professional | $45.89 | $52.75 | $59.34 |