| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $775.53 | $775.53 | $1,400.00 | |
CareSource
| Facility | $783.93 | $847.38 | $923.24 | |
Cigna
| Facility | $869.41 | $869.41 | $869.41 | |
United
| Facility | $10,572.63 | $10,572.63 | $10,572.63 |