| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $719.43 | $719.43 | $1,600.00 | |
Aetna
| Facility | 50 | $14,307.95 | $14,307.95 | $14,307.95 |
CareSource
| Facility | $802.22 | $894.40 | $974.46 | |
Cigna
| Facility | $858.91 | $858.91 | $858.91 |