| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $835.75 | $835.75 | $1,400.00 | |
CareSource
| Facility | $957.00 | $1,104.66 | $1,203.54 | |
Cigna
| Facility | $1,024.82 | $1,024.82 | $1,024.82 | |
Cigna
| Facility | AS | $101.85 | $101.85 | $101.85 |