| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $633.02 | $633.02 | $6,733.39 | |
Cigna
| Facility | $362.56 | $362.56 | $611.00 | |
Cigna
| Facility | 52 | $283.33 | $283.33 | $283.33 |
Cigna
| Facility | 53 | $70.84 | $70.84 | $70.84 |
Martin's Point
| Facility | $633.02 | $6,733.39 | $6,733.39 |