| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,164.27 | $1,400.00 | $2,600.00 | |
CareSource
| Facility | $1,251.21 | $1,400.65 | $1,526.03 | |
Cigna
| Facility | $1,338.52 | $1,338.52 | $1,338.52 | |
Cigna
| Facility | AS | $132.94 | $132.94 | $132.94 |