| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $80.04 | $80.04 | $80.04 | |
Aetna
| Professional | $80.04 | $80.04 | $96.05 | |
Cigna
| Facility | $80.04 | $80.04 | $80.04 | |
Cigna
| Professional | $80.04 | $80.04 | $80.04 | |
United
| Professional | $72.04 | $80.04 | $80.04 |