| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $182.37 | $362.69 | $1,400.00 | |
CareSource
| Facility | $242.79 | $280.88 | $306.02 | |
Cigna
| Facility | $260.63 | $260.63 | $260.63 | |
Cigna
| Facility | 62 | $159.84 | $159.84 | $159.84 |
Cigna
| Facility | AS | $25.58 | $25.58 | $25.58 |