| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $68.48 | $68.48 | $68.48 | |
Aetna
| Professional | $68.48 | $68.48 | $82.18 | |
Cigna
| Facility | $68.48 | $68.48 | $68.48 | |
Cigna
| Professional | $68.48 | $68.48 | $68.48 | |
United
| Professional | $59.59 | $68.48 | $68.48 |