| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,167.74 | $1,167.74 | $1,798.59 | |
CareSource
| Facility | $1,223.08 | $1,392.88 | $1,517.56 | |
Cigna
| Facility | $1,309.66 | $1,309.66 | $1,309.66 | |
Cigna
| Facility | AS | $128.44 | $128.44 | $128.44 |