| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $791.41 | $791.41 | $791.41 | |
Aetna
| Professional | $791.41 | $928.59 | $928.59 | |
Cigna
| Professional | $271.26 | $271.26 | $271.26 | |
Medica
| Facility | $1,331.94 | $1,337.48 | $1,857.18 |