| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $966.05 | $966.05 | $1,400.00 | |
CareSource
| Facility | $964.96 | $1,110.34 | $1,209.74 | |
Cigna
| Facility | $1,034.98 | $1,034.98 | $1,034.98 | |
Cigna
| Facility | AS | $100.21 | $100.21 | $100.21 |