| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,243.50 | $3,243.94 | $8,910.90 | |
Aetna
| Facility | 22 | $6,948.75 | $6,948.75 | $6,948.75 |
Cigna
| Facility | $837.00 | $837.00 | $837.00 | |
United
| Facility | $3,713.00 | $6,315.00 | $12,945.00 |