| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $100.00 | $383.57 | $8,965.00 | |
Cigna
| Facility | $293.27 | $5,257.46 | $5,441.47 | |
Cigna
| Facility | 62 | $179.89 | $179.89 | $179.89 |
Cigna
| Facility | AS | $28.78 | $28.78 | $28.78 |
United
| Facility | $7,448.00 | $7,448.00 | $7,448.00 |