| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $260.01 | $260.01 | $260.01 | |
Aetna
| Professional | $260.01 | $260.01 | $411.25 | |
Cigna
| Facility | $7,419.64 | $7,419.64 | $7,419.64 | |
Medica
| Facility | $234.24 | $260.01 | $3,370.06 |