| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $503.85 | $768.82 | $1,400.00 | |
CareSource
| Facility | $513.72 | $595.39 | $648.69 | |
Cigna
| Facility | $550.42 | $550.42 | $550.42 | |
Cigna
| Facility | 62 | $337.64 | $337.64 | $337.64 |
Cigna
| Facility | AS | $54.02 | $54.02 | $54.02 |