| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $111.15 | $111.15 | $112.26 | |
Cigna
| Facility | $111.15 | $111.15 | $111.15 | |
Cigna
| Professional | $111.15 | $111.15 | $111.15 | |
United
| Professional | $88.92 | $111.15 | $244.53 |