| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $194.35 | $194.35 | $194.35 | |
Aetna
| Professional | $147.82 | $194.35 | $221.37 | |
Cigna
| Professional | $216.38 | $216.38 | $216.38 | |
United
| Professional | $221.48 | $254.57 | $254.57 |