| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $177.83 | $1,995.26 | $4,897.79 | |
Aetna
| Facility | 50 | $4,265.80 | $4,265.80 | $4,265.80 |
Cigna
| Facility | $10,964.78 | $10,964.78 | $10,964.78 | |
United
| Facility | $223.87 | $562.34 | $1,479.11 |