| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $656.25 | $656.25 | $8,500.00 | |
Aetna
| Professional | $49.00 | $656.25 | $656.25 | |
Cigna
| Professional | $828.73 | $1,342.13 | $1,733.16 | |
Medica
| Facility | $656.25 | $656.25 | $1,968.75 |