| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $77.62 | $77.62 | $77.62 | |
Aetna
| Professional | $77.62 | $77.62 | $89.13 | |
Cigna
| Facility | $77.62 | $77.62 | $77.62 | |
Cigna
| Professional | $77.62 | $77.62 | $77.62 | |
United
| Facility | $74.13 | $83.18 | $100.00 | |
United
| Professional | $74.13 | $87.10 | $125.89 |