| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $402.32 | $3,738.49 | $12,429.33 | |
Aetna
| Professional | $402.32 | $3,306.43 | $4,972.50 | |
Cigna
| Professional | $1,054.93 | $1,054.93 | $1,054.93 | |
Medica
| Facility | $679.92 | $5,587.87 | $9,059.62 |