| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,083.29 | $1,524.82 | $14,264.51 | |
CareSource
| Facility | $1,056.74 | $1,180.85 | $1,286.56 | |
Cigna
| Facility | $1,126.75 | $1,126.75 | $1,126.75 | |
Cigna
| Facility | AS | $111.77 | $111.77 | $111.77 |