| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $718.00 | $762.88 | $762.88 | |
Cigna
| Facility | $762.88 | $762.88 | $762.88 | |
Cigna
| Professional | $762.88 | $762.88 | $762.88 | |
United
| Professional | $1,697.88 | $1,997.50 | $4,394.50 |