| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,090.02 | $1,090.02 | $1,400.00 | |
CareSource
| Facility | $1,152.33 | $1,314.80 | $1,432.50 | |
Cigna
| Facility | $1,234.92 | $1,234.92 | $1,234.92 | |
Cigna
| Facility | AS | $120.91 | $120.91 | $120.91 |