| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $670.53 | $3,500.00 | $11,548.32 | |
Aetna
| Facility | 52 | $335.27 | $335.27 | $335.27 |
Aetna
| Facility | 53 | $134.11 | $134.11 | $134.11 |
CareSource
| Facility | $689.46 | $788.56 | $859.14 | |
Cigna
| Facility | $740.60 | $740.60 | $740.60 | |
Cigna
| Facility | 52 | $575.63 | $575.63 | $575.63 |
Cigna
| Facility | 53 | $143.91 | $143.91 | $143.91 |