| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $128.82 | $128.82 | $1,412.54 | |
CareSource
| Facility | $128.82 | $128.82 | $162.18 | |
Cigna
| Facility | $34.67 | $208.93 | $208.93 | |
Cigna
| Facility | 62 | $128.82 | $128.82 | $128.82 |
Cigna
| Facility | AS | $20.89 | $20.89 | $20.89 |
United
| Facility | $457.09 | $457.09 | $457.09 |