| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $195.88 | $195.88 | $1,400.00 | |
CareSource
| Facility | $194.94 | $224.20 | $244.27 | |
Cigna
| Facility | $209.45 | $209.45 | $209.45 | |
Cigna
| Facility | AS | $20.28 | $20.28 | $20.28 |
United
| Facility | $765.00 | $765.00 | $765.00 |