| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $51.29 | $51.29 | $51.29 | |
Aetna
| Professional | $51.29 | $51.29 | $112.20 | |
Cigna
| Facility | $56.23 | $56.23 | $56.23 | |
Cigna
| Professional | $51.29 | $51.29 | $51.29 | |
MVP Health Care
| Facility | $51.29 | $51.29 | $51.29 | |
MVP Health Care
| Professional | $51.29 | $51.29 | $51.29 | |
United
| Professional | $22.39 | $51.29 | $117.49 |