| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $850.46 | $850.46 | $1,700.00 | |
CareSource
| Facility | $958.11 | $1,070.78 | $1,166.64 | |
Cigna
| Facility | $1,033.26 | $1,033.26 | $1,033.26 | |
Cigna
| Facility | AS | $101.48 | $101.48 | $101.48 |