| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $362.41 | $362.41 | $1,400.00 | |
CareSource
| Facility | $373.29 | $426.34 | $464.51 | |
Cigna
| Facility | $401.09 | $401.09 | $401.09 | |
Cigna
| Facility | 62 | $243.96 | $243.96 | $243.96 |
Cigna
| Facility | AS | $39.03 | $39.03 | $39.03 |