| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $101.72 | $101.72 | $101.72 | |
Aetna
| Professional | $101.72 | $101.72 | $111.89 | |
Cigna
| Facility | $101.72 | $101.72 | $101.72 | |
Cigna
| Professional | $101.72 | $101.72 | $101.72 | |
United
| Professional | $88.50 | $101.72 | $101.72 |