| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $827.62 | $1,200.00 | $1,400.00 | |
CareSource
| Facility | $866.57 | $1,003.85 | $1,093.70 | |
Cigna
| Facility | $928.06 | $928.06 | $928.06 | |
Cigna
| Facility | 62 | $569.25 | $569.25 | $569.25 |
Cigna
| Facility | AS | $91.08 | $91.08 | $91.08 |