| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $3,864.00 | $4,105.50 | $4,105.50 | |
Cigna
| Facility | $4,105.50 | $4,105.50 | $4,105.50 | |
Cigna
| Professional | $4,105.50 | $4,105.50 | $4,105.50 | |
United
| Professional | $2,737.00 | $4,200.00 | $6,807.28 |