| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,600.00 | $13,310.40 | $24,679.70 | |
CareSource
| Facility | $939.33 | $1,044.82 | $1,138.33 | |
Cigna
| Facility | $1,007.33 | $1,007.33 | $1,007.33 | |
Cigna
| Facility | AS | $100.51 | $100.51 | $100.51 |