| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $875.28 | $1,358.94 | $1,600.00 | |
CareSource
| Facility | $939.39 | $1,052.40 | $1,146.60 | |
Cigna
| Facility | $1,006.12 | $1,006.12 | $1,006.12 | |
Cigna
| Facility | AS | $99.84 | $99.84 | $99.84 |