| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $958.26 | $1,400.00 | $2,600.00 | |
CareSource
| Facility | $1,025.05 | $1,149.79 | $1,252.72 | |
Cigna
| Facility | $1,094.72 | $1,094.72 | $1,094.72 | |
Cigna
| Facility | AS | $108.42 | $108.42 | $108.42 |