| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $567.37 | $11,713.34 | $11,713.34 | |
Aetna
| Facility | 50 | $8,271.20 | $8,271.20 | $8,271.20 |
CareSource
| Facility | $538.05 | $645.66 | $703.47 | |
Cigna
| Facility | $627.16 | $627.16 | $627.16 |