| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $663.63 | $663.63 | $663.63 | |
Aetna
| Professional | $663.63 | $663.63 | $796.35 | |
Cigna
| Facility | $663.63 | $663.63 | $663.63 | |
Cigna
| Professional | $663.63 | $663.63 | $663.63 | |
United
| Professional | $577.36 | $663.63 | $663.63 |