| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,400.00 | $1,869.76 | $3,189.87 | |
CareSource
| Facility | $2,121.34 | $2,470.32 | $2,691.45 | |
Cigna
| Facility | $2,269.32 | $2,269.32 | $2,269.32 | |
Cigna
| Facility | AS | $225.03 | $225.03 | $225.03 |