| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $671.95 | $1,049.39 | $1,400.00 | |
Aetna
| Facility | 54 | $503.96 | $503.96 | $787.04 |
CareSource
| Facility | $726.15 | $812.69 | $885.42 | |
Cigna
| Facility | $778.31 | $778.31 | $778.31 | |
Cigna
| Facility | 54 | $541.79 | $541.79 | $541.79 |