| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,513.56 | $1,513.56 | $1,513.56 | |
Cigna
| Facility | $67.61 | $67.61 | $691.83 | |
Cigna
| Facility | 52 | $54.95 | $54.95 | $54.95 |
Cigna
| Facility | 53 | $13.80 | $13.80 | $13.80 |
Martin's Point
| Facility | $1,513.56 | $1,513.56 | $1,513.56 |