| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,300.80 | $1,300.80 | $1,400.00 | |
CareSource
| Facility | $1,298.05 | $1,495.73 | $1,629.61 | |
Cigna
| Facility | $1,399.51 | $1,399.51 | $1,399.51 | |
Cigna
| Facility | AS | $135.63 | $135.63 | $135.63 |