| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,053.80 | $1,053.80 | $1,400.00 | |
CareSource
| Facility | $1,115.58 | $1,269.80 | $1,383.47 | |
Cigna
| Facility | $1,193.27 | $1,193.27 | $1,193.27 | |
Cigna
| Facility | AS | $116.84 | $116.84 | $116.84 |