| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $186.21 | $287.25 | $1,400.00 | |
Aetna
| Facility | 54 | $139.66 | $139.66 | $215.44 |
CareSource
| Facility | $193.96 | $222.44 | $242.37 | |
Cigna
| Facility | $208.02 | $208.02 | $208.02 | |
Cigna
| Facility | 54 | $140.13 | $140.13 | $140.13 |