| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,400.00 | $2,619.30 | $2,619.30 | |
CareSource
| Facility | $2,956.17 | $3,449.27 | $3,758.02 | |
Cigna
| Facility | $3,171.89 | $3,171.89 | $3,171.89 | |
Cigna
| Facility | AS | $314.18 | $314.18 | $314.18 |