| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $100.00 | $1,213.44 | $8,323.29 | |
Cigna
| Facility | $368.90 | $368.90 | $368.90 | |
Cigna
| Facility | 62 | $225.79 | $225.79 | $225.79 |
Cigna
| Facility | AS | $36.13 | $36.13 | $36.13 |
United
| Facility | $12,399.00 | $12,399.00 | $12,399.00 |