| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $489.87 | $489.87 | $8,500.00 | |
Aetna
| Professional | $452.17 | $489.87 | $489.87 | |
Cigna
| Professional | $627.35 | $627.35 | $1,399.49 | |
Medica
| Facility | $489.87 | $489.87 | $1,469.61 |