| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $176.18 | $1,831.00 | $4,902.20 | |
Aetna
| Facility | 50 | $4,301.92 | $4,301.92 | $4,301.92 |
Cigna
| Facility | $10,477.79 | $10,477.79 | $10,477.79 | |
United
| Facility | $216.00 | $491.00 | $1,650.00 |