| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $487.08 | $756.05 | $1,400.00 | |
Aetna
| Facility | 54 | $365.31 | $365.31 | $567.04 |
CareSource
| Facility | $526.92 | $585.50 | $637.91 | |
Cigna
| Facility | $566.54 | $566.54 | $566.54 | |
Cigna
| Facility | 54 | $394.33 | $394.33 | $394.33 |