| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $892.00 | $1,831.00 | $2,825.00 | |
Aetna
| Facility | 54 | $826.90 | $826.90 | $2,003.31 |
Cigna
| Facility | $1,000.00 | $1,000.00 | $1,000.00 | |
United
| Facility | $985.00 | $3,572.00 | $9,515.00 |