| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,400.00 | $5,858.97 | $5,858.97 | |
Aetna
| Facility | 54 | $571.88 | $571.88 | $571.88 |
CareSource
| Facility | $789.46 | $858.52 | $935.37 | |
Cigna
| Facility | $851.89 | $851.89 | $851.89 | |
Cigna
| Facility | 54 | $596.32 | $596.32 | $596.32 |