| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $679.28 | $679.28 | $679.28 | |
Aetna
| Professional | $679.28 | $679.28 | $679.28 | |
Cigna
| Facility | $989.22 | $989.22 | $989.22 | |
Cigna
| Professional | $122.53 | $989.22 | $1,807.50 | |
Molina
| Professional | $60.00 | $60.00 | $60.00 | |
United
| Professional | $638.50 | $784.30 | $1,368.47 |