| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $106.70 | $106.70 | $106.70 | |
Aetna
| Professional | $106.70 | $106.70 | $128.04 | |
Cigna
| Facility | $106.70 | $106.70 | $106.70 | |
Cigna
| Professional | $106.70 | $106.70 | $255.16 | |
United
| Professional | $92.83 | $106.70 | $130.16 |