| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $656.12 | $656.12 | $656.12 | |
Aetna
| Professional | $656.12 | $656.12 | $721.74 | |
Cigna
| Facility | $656.12 | $656.12 | $656.12 | |
Cigna
| Professional | $656.12 | $656.12 | $656.12 | |
United
| Professional | $570.82 | $656.12 | $656.12 |