| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $886.90 | $886.90 | $1,400.00 | |
CareSource
| Facility | $940.82 | $1,072.55 | $1,168.55 | |
Cigna
| Facility | $1,008.35 | $1,008.35 | $1,008.35 | |
Cigna
| Facility | AS | $98.91 | $98.91 | $98.91 |