| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $85.29 | $85.29 | $1,400.00 | |
CareSource
| Facility | $88.50 | $100.91 | $109.94 | |
Cigna
| Facility | $94.88 | $94.88 | $94.88 | |
Cigna
| Facility | AS | $9.25 | $9.25 | $9.25 |
United
| Facility | $460.00 | $460.00 | $460.00 |