| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $112.32 | $112.32 | $112.32 | |
Aetna
| Professional | $112.32 | $112.32 | $134.78 | |
Cigna
| Facility | $112.32 | $112.32 | $112.32 | |
Cigna
| Professional | $112.32 | $112.32 | $112.32 | |
United
| Professional | $97.72 | $112.32 | $112.32 |