| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $363.47 | $566.08 | $1,400.00 | |
CareSource
| Facility | $380.88 | $438.38 | $477.63 | |
Cigna
| Facility | $408.17 | $408.17 | $408.17 | |
Cigna
| Facility | 62 | $250.26 | $250.26 | $250.26 |
Cigna
| Facility | AS | $40.04 | $40.04 | $40.04 |