| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,606.00 | $4,606.00 | $4,606.00 | |
Cigna
| Facility | $39,634.12 | $39,634.12 | $39,634.12 | |
HMSA
| Facility | $14,692.00 | $17,167.00 | $19,991.00 | |
United
| Facility | $3,775.00 | $3,775.00 | $3,775.00 |