| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $106.97 | $106.97 | $106.97 | |
Aetna
| Professional | $106.97 | $106.97 | $117.66 | |
Cigna
| Facility | $106.97 | $106.97 | $106.97 | |
Cigna
| Professional | $106.97 | $106.97 | $106.97 | |
United
| Professional | $93.06 | $106.97 | $106.97 |