| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $304.69 | $304.69 | $304.69 | |
Aetna
| Professional | $75.00 | $75.00 | $79.69 | |
Cigna
| Facility | $79.50 | $79.50 | $79.50 | |
Cigna
| Professional | $79.50 | $79.50 | $79.50 | |
United
| Professional | $90.69 | $90.69 | $133.34 |