| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $585.58 | $585.58 | $585.58 | |
Aetna
| Professional | $422.64 | $422.64 | $422.64 | |
Cigna
| Professional | $585.22 | $585.22 | $731.53 | |
United
| Professional | $213.86 | $305.52 | $763.80 |