| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $791.14 | $791.14 | $1,600.00 | |
CareSource
| Facility | $898.23 | $1,037.99 | $1,130.91 | |
Cigna
| Facility | $963.59 | $963.59 | $963.59 | |
Cigna
| Facility | 62 | $599.30 | $599.30 | $599.30 |
Cigna
| Facility | AS | $95.89 | $95.89 | $95.89 |