| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $162.97 | $162.97 | $180.90 | |
Aetna
| Professional | $162.97 | $162.97 | $180.90 | |
BCBS
| Facility | $141.36 | $141.36 | $141.36 | |
Cigna
| Facility | $190.27 | $203.81 | $203.81 | |
Cigna
| Professional | $203.81 | $203.81 | $203.81 | |
United
| Professional | $162.97 | $181.07 | $218.36 |