| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $65.88 | $65.88 | $65.88 | |
Aetna
| Professional | $65.88 | $65.88 | $79.06 | |
Cigna
| Facility | $65.88 | $65.88 | $65.88 | |
Cigna
| Professional | $65.88 | $65.88 | $239.87 | |
United
| Professional | $59.29 | $65.88 | $65.88 |