| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,400.00 | $1,514.37 | $1,514.37 | |
CareSource
| Facility | $1,510.48 | $1,741.24 | $1,897.10 | |
Cigna
| Facility | $1,623.92 | $1,623.92 | $1,623.92 | |
Cigna
| Facility | AS | $157.26 | $157.26 | $157.26 |