| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $109.44 | $109.44 | $109.44 | |
Aetna
| Professional | $109.44 | $109.44 | $131.32 | |
Cigna
| Facility | $109.44 | $109.44 | $109.44 | |
Cigna
| Professional | $109.44 | $109.44 | $109.44 | |
United
| Professional | $93.02 | $109.44 | $109.44 |