| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,606.00 | $4,606.00 | $4,606.00 | |
Cigna
| Facility | $22,951.63 | $22,951.63 | $22,951.63 | |
HMSA
| Facility | $11,796.00 | $13,784.00 | $16,051.00 | |
United
| Facility | $3,775.00 | $3,775.00 | $3,775.00 |