| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $51.29 | $93.33 | $181.97 | |
Cigna
| Facility | $169.82 | $169.82 | $169.82 | |
Cigna
| Professional | $144.54 | $144.54 | $144.54 | |
United
| Facility | $0.15 | $125.89 | $144.54 | |
United
| Professional | $95.50 | $125.89 | $158.49 |