| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $534.78 | $534.78 | $1,700.00 | |
Aetna
| Facility | 53 | $106.96 | $106.96 | $106.96 |
CareSource
| Facility | $533.54 | $607.75 | $662.15 | |
Cigna
| Facility | $572.48 | $572.48 | $572.48 | |
Cigna
| Facility | 53 | $111.77 | $111.77 | $111.77 |