| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $171.96 | $171.96 | $171.96 | |
Aetna
| Professional | $134.90 | $171.96 | $332.76 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $354.90 | $354.90 | $354.90 | |
United
| Professional | $699.93 | $699.93 | $699.93 |