| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,201.28 | $2,201.28 | $4,586.04 | |
Cigna
| Facility | $654.54 | $654.54 | $863.00 | |
Cigna
| Facility | AS | $64.65 | $64.65 | $64.65 |
Martin's Point
| Facility | $2,201.28 | $2,201.28 | $4,586.04 |