| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,400.00 | $2,067.14 | $2,067.14 | |
CareSource
| Facility | $2,315.26 | $2,574.84 | $2,805.33 | |
Cigna
| Facility | $2,478.02 | $2,478.02 | $2,478.02 | |
Cigna
| Facility | 62 | $1,508.29 | $1,508.29 | $1,508.29 |
Cigna
| Facility | AS | $241.33 | $241.33 | $241.33 |