| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $363.41 | $570.26 | $1,400.00 | |
CareSource
| Facility | $382.62 | $441.62 | $481.15 | |
Cigna
| Facility | $409.31 | $409.31 | $409.31 | |
Cigna
| Facility | 62 | $250.96 | $250.96 | $250.96 |
Cigna
| Facility | AS | $40.15 | $40.15 | $40.15 |