| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $971.00 | $971.00 | $2,600.00 | |
CareSource
| Facility | $1,069.01 | $1,212.09 | $1,320.60 | |
Cigna
| Facility | $1,146.72 | $1,146.72 | $1,146.72 | |
Cigna
| Facility | AS | $112.67 | $112.67 | $112.67 |