| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $641.46 | $641.46 | $3,550.00 | |
CareSource
| Facility | $646.64 | $741.52 | $807.89 | |
Cigna
| Facility | $693.44 | $693.44 | $693.44 | |
Cigna
| Facility | AS | $67.63 | $67.63 | $67.63 |
United
| Facility | $4,439.00 | $4,439.00 | $4,439.00 |