| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $447.62 | $447.62 | $447.62 | |
Cigna
| Facility | $867.37 | $867.37 | $867.37 | |
Cigna
| Professional | $103.85 | $867.37 | $1,530.00 | |
Molina
| Professional | $448.52 | $790.95 | $964.58 | |
United
| Professional | $447.62 | $660.24 | $994.70 |