| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $107.15 | $107.15 | $107.15 | |
Aetna
| Professional | $107.15 | $107.15 | $128.82 | |
Cigna
| Facility | $107.15 | $107.15 | $107.15 | |
Cigna
| Professional | $107.15 | $107.15 | $107.15 | |
United
| Facility | $38.02 | $38.02 | $117.49 | |
United
| Professional | $38.02 | $93.33 | $125.89 |