| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $628.07 | $628.07 | $628.07 | |
Aetna
| Professional | $628.07 | $628.07 | $628.07 | |
Cigna
| Facility | $881.10 | $881.10 | $881.10 | |
Cigna
| Professional | $109.87 | $881.10 | $1,620.00 | |
Molina
| Professional | $60.00 | $60.00 | $60.00 | |
United
| Professional | $665.29 | $826.52 | $1,265.25 |