| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,400.00 | $1,631.29 | $36,164.31 | |
CareSource
| Facility | $1,684.37 | $1,913.50 | $2,084.79 | |
Cigna
| Facility | $1,806.52 | $1,806.52 | $1,806.52 | |
Cigna
| Facility | AS | $176.72 | $176.72 | $176.72 |