| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $759.56 | $759.56 | $1,400.00 | |
Aetna
| Facility | 52 | $379.78 | $379.78 | $379.78 |
CareSource
| Facility | $856.23 | $948.58 | $1,033.49 | |
Cigna
| Facility | $916.21 | $916.21 | $916.21 | |
Cigna
| Facility | 52 | $718.20 | $718.20 | $718.20 |