| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,162.71 | $1,162.71 | $1,162.71 | |
Aetna
| Professional | $1,162.71 | $1,162.71 | $1,162.71 | |
Cigna
| Professional | $163.71 | $1,503.13 | $2,925.00 | |
Molina
| Professional | $67.11 | $118.35 | $187.22 | |
United
| Professional | $1,092.81 | $1,108.67 | $2,341.96 |