| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $209.09 | $209.09 | $209.09 | |
Aetna
| Professional | $183.53 | $209.09 | $229.38 | |
Cigna
| Professional | $290.73 | $290.73 | $290.73 | |
United
| Professional | $292.94 | $464.98 | $845.72 |