| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $217.44 | $217.44 | $1,400.00 | |
CareSource
| Facility | $215.86 | $249.73 | $272.08 | |
Cigna
| Facility | $232.31 | $232.31 | $232.31 | |
Cigna
| Facility | 62 | $140.04 | $140.04 | $140.04 |
Cigna
| Facility | AS | $22.41 | $22.41 | $22.41 |