| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $340.08 | $340.08 | $1,400.00 | |
CareSource
| Facility | $337.76 | $390.16 | $425.09 | |
Cigna
| Facility | $363.14 | $363.14 | $363.14 | |
Cigna
| Facility | 62 | $218.80 | $218.80 | $218.80 |
Cigna
| Facility | AS | $35.01 | $35.01 | $35.01 |