| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $316.23 | $316.23 | $2,754.23 | |
Aetna
| Professional | $316.23 | $316.23 | $478.63 | |
Cigna
| Facility | $1,513.56 | $1,513.56 | $1,513.56 | |
Medica
| Facility | $426.58 | $630.96 | $851.14 |