| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $2,068.46 | $2,068.46 | $2,068.46 | |
Cigna
| Facility | $2,068.46 | $2,068.46 | $2,068.46 | |
Cigna
| Professional | $2,068.46 | $2,068.46 | $2,068.46 | |
United
| Professional | $2,068.46 | $2,068.46 | $3,366.16 |