| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,412.54 | $1,412.54 | $1,412.54 | |
Aetna
| Professional | $1.00 | $1.00 | $2.00 | |
Cigna
| Facility | $64.57 | $64.57 | $64.57 | |
Cigna
| Professional | $18.20 | $18.20 | $18.20 | |
United
| Facility | $104.71 | $104.71 | $104.71 |