| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $75.79 | $75.79 | $75.79 | |
Aetna
| Professional | $75.79 | $75.79 | $90.95 | |
Cigna
| Facility | $75.79 | $75.79 | $75.79 | |
Cigna
| Professional | $75.79 | $75.79 | $75.79 | |
United
| Professional | $64.42 | $75.79 | $90.95 |