| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $764.55 | $764.55 | $764.55 | |
Aetna
| Professional | $764.55 | $764.55 | $764.55 | |
Cigna
| Facility | $1,122.47 | $1,122.47 | $1,459.20 | |
Cigna
| Professional | $140.82 | $1,122.47 | $2,077.50 | |
Molina
| Professional | $60.00 | $60.00 | $60.00 | |
United
| Professional | $718.65 | $883.25 | $1,540.24 |