| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,400.00 | $3,498.93 | $3,498.93 | |
CareSource
| Facility | $3,516.54 | $4,031.11 | $4,391.96 | |
Cigna
| Facility | $3,773.41 | $3,773.41 | $3,773.41 | |
Cigna
| Facility | AS | $366.86 | $366.86 | $366.86 |