| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,400.00 | $1,758.15 | $1,758.15 | |
CareSource
| Facility | $1,749.83 | $2,018.68 | $2,199.38 | |
Cigna
| Facility | $1,881.48 | $1,881.48 | $1,881.48 | |
Cigna
| Facility | AS | $182.09 | $182.09 | $182.09 |