| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $870.96 | $870.96 | $870.96 | |
Aetna
| Professional | $588.84 | $616.60 | $758.58 | |
Cigna
| Professional | $870.96 | $870.96 | $1,071.52 | |
United
| Professional | $263.03 | $446.68 | $1,122.02 |