| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,074.43 | $1,400.00 | $2,600.00 | |
CareSource
| Facility | $1,126.43 | $1,126.43 | $1,397.26 | |
Cigna
| Facility | $1,217.95 | $1,217.95 | $1,217.95 | |
Cigna
| Facility | AS | $121.06 | $121.06 | $121.06 |