| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $995.63 | $995.63 | $1,400.00 | |
CareSource
| Facility | $994.63 | $1,144.54 | $1,247.00 | |
Cigna
| Facility | $1,068.33 | $1,068.33 | $1,068.33 | |
Cigna
| Facility | AS | $103.68 | $103.68 | $103.68 |