| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,079.93 | $1,700.00 | $13,820.38 | |
CareSource
| Facility | $1,172.94 | $1,340.84 | $1,460.86 | |
Cigna
| Facility | $1,255.08 | $1,255.08 | $1,255.08 | |
Cigna
| Facility | AS | $124.52 | $124.52 | $124.52 |