| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $111.15 | $111.15 | $111.15 | |
Aetna
| Professional | $111.15 | $111.15 | $133.38 | |
Cigna
| Facility | $111.15 | $111.15 | $111.15 | |
Cigna
| Professional | $111.15 | $111.15 | $111.15 | |
United
| Professional | $96.70 | $111.15 | $111.15 |