| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,400.00 | $1,657.34 | $1,657.34 | |
CareSource
| Facility | $1,747.21 | $1,997.09 | $2,175.86 | |
Cigna
| Facility | $1,874.50 | $1,874.50 | $1,874.50 | |
Cigna
| Facility | AS | $183.17 | $183.17 | $183.17 |