| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $517.50 | $517.50 | $8,500.00 | |
Aetna
| Professional | $517.50 | $517.50 | $517.50 | |
Cigna
| Professional | $710.70 | $1,150.98 | $1,486.32 | |
Medica
| Facility | $517.50 | $517.50 | $1,552.50 |