| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,875.00 | $1,875.00 | $8,500.00 | |
Aetna
| Professional | $1,875.00 | $1,875.00 | $1,875.00 | |
Cigna
| Professional | $1,591.38 | $2,360.33 | $3,328.13 | |
Medica
| Facility | $1,875.00 | $1,875.00 | $5,625.00 |