| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $136.44 | $208.37 | $1,700.00 | |
CareSource
| Facility | $141.31 | $161.36 | $175.81 | |
Cigna
| Facility | $152.81 | $152.81 | $152.81 | |
Cigna
| Facility | AS | $14.95 | $14.95 | $14.95 |
Prtl Exc Pst Vrt Intrnsc B1y Les 1 Vrt Sgm Ea
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $136.44 | $208.37 | $1,700.00 | |
CareSource
| Facility | $141.31 | $161.36 | $175.81 | |
Cigna
| Facility | $152.81 | $152.81 | $152.81 | |
Cigna
| Facility | AS | $14.95 | $14.95 | $14.95 |