| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $767.93 | $767.93 | $1,400.00 | |
CareSource
| Facility | $767.29 | $882.71 | $961.73 | |
Cigna
| Facility | $823.68 | $823.68 | $823.68 | |
Cigna
| Facility | AS | $79.75 | $79.75 | $79.75 |
United
| Facility | $765.00 | $765.00 | $765.00 |