| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $122.59 | $692.27 | $1,600.00 | |
CareSource
| Facility | $132.04 | $148.49 | $161.78 | |
Cigna
| Facility | $211.73 | $211.73 | $211.73 | |
United
| Facility | $1,225.00 | $1,225.00 | $1,225.00 |