| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $758.58 | $758.58 | $3,467.37 | |
CareSource
| Facility | $776.25 | $776.25 | $954.99 | |
Cigna
| Facility | $1,174.90 | $1,174.90 | $1,174.90 | |
United
| Facility | $758.58 | $758.58 | $758.58 |