| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $89.75 | $89.75 | $89.75 | |
Aetna
| Professional | $89.75 | $89.75 | $98.72 | |
Cigna
| Facility | $89.75 | $89.75 | $89.75 | |
Cigna
| Professional | $89.75 | $89.75 | $89.75 | |
United
| Professional | $78.08 | $89.75 | $89.75 |