| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $287.44 | $433.78 | $1,600.00 | |
Aetna
| Facility | 52 | $143.72 | $143.72 | $216.89 |
CareSource
| Facility | $302.76 | $335.93 | $366.00 | |
Cigna
| Facility | $325.48 | $325.48 | $325.48 | |
Cigna
| Facility | 52 | $254.41 | $254.41 | $254.41 |