| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $585.04 | $585.04 | $585.04 | |
Aetna
| Professional | $585.04 | $585.04 | $1,771.57 | |
Cigna
| Facility | $603.87 | $603.87 | $603.87 | |
Cigna
| Professional | $1,000.73 | $1,000.73 | $1,000.73 | |
United
| Professional | $683.77 | $683.77 | $683.77 |