| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $162.18 | $162.18 | $162.18 | |
Aetna
| Professional | $162.18 | $162.18 | $218.78 | |
Cigna
| Facility | $162.18 | $162.18 | $162.18 | |
Cigna
| Professional | $162.18 | $162.18 | $162.18 | |
United
| Facility | $144.54 | $169.82 | $446.68 | |
United
| Professional | $120.23 | $173.78 | $371.54 |