| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $263.63 | $263.63 | $1,400.00 | |
CareSource
| Facility | $268.73 | $294.89 | $321.29 | |
Cigna
| Facility | $288.52 | $288.52 | $288.52 | |
United
| Facility | $6,540.83 | $6,540.83 | $6,540.83 |