| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,400.00 | $1,479.62 | $1,479.62 | |
CareSource
| Facility | $1,673.12 | $1,932.32 | $2,105.30 | |
Cigna
| Facility | $1,795.20 | $1,795.20 | $1,795.20 | |
Cigna
| Facility | 62 | $1,109.83 | $1,109.83 | $1,109.83 |