| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,412.54 | $3,801.89 | $3,801.89 | |
CareSource
| Facility | $3,801.89 | $3,801.89 | $4,786.30 | |
Cigna
| Facility | $34.67 | $6,025.60 | $6,025.60 | |
United
| Facility | $758.58 | $758.58 | $758.58 |