| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $97.94 | $97.94 | $97.94 | |
Aetna
| Professional | $97.94 | $97.94 | $107.73 | |
Cigna
| Facility | $97.94 | $97.94 | $97.94 | |
Cigna
| Professional | $97.94 | $97.94 | $97.94 | |
United
| Professional | $88.15 | $97.94 | $102.79 |