| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,400.00 | $1,754.85 | $1,754.85 | |
CareSource
| Facility | $1,740.67 | $2,008.25 | $2,188.01 | |
Cigna
| Facility | $1,873.04 | $1,873.04 | $1,873.04 | |
Cigna
| Facility | AS | $181.19 | $181.19 | $181.19 |