| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $161.50 | $161.50 | $161.50 | |
Aetna
| Professional | $152.00 | $161.50 | $161.50 | |
Cigna
| Facility | $161.50 | $161.50 | $161.50 | |
Cigna
| Professional | $161.50 | $161.50 | $161.50 | |
United
| Professional | $145.72 | $167.51 | $167.51 |