| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $166.91 | $274.67 | $1,400.00 | |
CareSource
| Facility | $185.46 | $212.71 | $231.75 | |
Cigna
| Facility | $199.25 | $199.25 | $199.25 | |
Cigna
| Facility | AS | $19.50 | $19.50 | $19.50 |
United
| Facility | $765.00 | $765.00 | $765.00 |