| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $38.90 | $38.90 | $38.90 | |
Aetna
| Professional | $38.90 | $38.90 | $46.77 | |
Cigna
| Facility | $38.90 | $38.90 | $38.90 | |
Cigna
| Professional | $38.90 | $38.90 | $38.90 | |
United
| Facility | $446.68 | $446.68 | $812.83 | |
United
| Professional | $120.23 | $616.60 | $954.99 |