| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $805.20 | $805.20 | $7,968.00 | |
Aetna
| Professional | $805.20 | $805.20 | $805.20 | |
Cigna
| Professional | $651.35 | $651.35 | $651.35 | |
Medcost
| Facility | $805.20 | $805.20 | $966.24 | |
United
| Facility | $806.00 | $3,994.00 | $6,543.00 | |
Wellcare
| Facility | $100.00 | $100.00 | $100.00 |