| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $304.83 | $459.58 | $1,700.00 | |
Aetna
| Facility | 54 | $228.62 | $228.62 | $344.69 |
CareSource
| Facility | $309.20 | $371.04 | $404.26 | |
Cigna
| Facility | $537.13 | $537.13 | $537.13 | |
Cigna
| Facility | 54 | $375.99 | $375.99 | $375.99 |