| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $100.00 | $100.00 | $9,859.00 | |
Cigna
| Facility | $260.63 | $5,257.46 | $5,441.47 | |
Cigna
| Facility | 62 | $159.84 | $159.84 | $159.84 |
Cigna
| Facility | AS | $25.58 | $25.58 | $25.58 |
United
| Facility | $7,448.00 | $7,448.00 | $7,448.00 |