| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $688.16 | $688.16 | $2,300.00 | |
Aetna
| Facility | 54 | $516.12 | $516.12 | $516.12 |
CareSource
| Facility | $711.48 | $773.81 | $843.09 | |
Cigna
| Facility | $767.27 | $767.27 | $767.27 | |
Cigna
| Facility | 54 | $537.09 | $537.09 | $537.09 |