| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $402.32 | $2,698.08 | $12,429.33 | |
Aetna
| Professional | $402.32 | $402.32 | $402.32 | |
Cigna
| Professional | $1,054.93 | $1,054.93 | $1,054.93 | |
Medica
| Facility | $402.32 | $402.32 | $1,206.96 |