| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $85.76 | $106.83 | $153.86 | |
Aetna
| Professional | $105.15 | $140.34 | $184.21 | |
Aetna
| Professional | 25 | $170.76 | $170.76 | $170.76 |
Cigna
| Facility | $174.07 | $174.07 | $174.07 | |
Cigna
| Professional | $147.90 | $147.90 | $606.50 | |
United
| Professional | $83.17 | $133.97 | $222.33 |