| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,136.19 | $1,136.19 | $1,400.00 | |
CareSource
| Facility | $1,133.44 | $1,304.22 | $1,420.97 | |
Cigna
| Facility | $1,218.08 | $1,218.08 | $1,218.08 | |
Cigna
| Facility | AS | $118.22 | $118.22 | $118.22 |