| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,400.00 | $4,428.88 | $4,428.88 | |
Aetna
| Facility | 54 | $586.57 | $586.57 | $586.57 |
CareSource
| Facility | $810.01 | $881.24 | $960.12 | |
Cigna
| Facility | $872.76 | $872.76 | $872.76 | |
Cigna
| Facility | 54 | $610.67 | $610.67 | $610.67 |