| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $793.42 | $793.42 | $793.42 | |
Aetna
| Professional | $774.75 | $793.42 | $793.42 | |
Cigna
| Facility | $793.42 | $793.42 | $793.42 | |
Cigna
| Professional | $793.42 | $793.42 | $793.42 | |
United
| Professional | $777.86 | $777.86 | $841.77 |