| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $203.62 | $2,547.00 | $10,635.00 | |
Aetna
| Facility | 50 | $17,717.12 | $17,717.12 | $17,717.12 |
CareSource
| Facility | $117.96 | $171.77 | $216.84 | |
Cigna
| Facility | $21,571.00 | $21,571.00 | $21,571.00 | |
United
| Facility | $444.00 | $979.00 | $3,218.00 |