| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,184.82 | $1,400.00 | $2,600.00 | |
CareSource
| Facility | $1,273.28 | $1,425.78 | $1,553.40 | |
Cigna
| Facility | $1,360.16 | $1,360.16 | $1,360.16 | |
Cigna
| Facility | AS | $135.00 | $135.00 | $135.00 |