| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $85.11 | $85.11 | $1,412.54 | |
CareSource
| Facility | $89.13 | $89.13 | $109.65 | |
Cigna
| Facility | $34.67 | $141.25 | $141.25 | |
Cigna
| Facility | AS | $14.13 | $14.13 | $14.13 |
United
| Facility | $457.09 | $457.09 | $457.09 |