| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,258.99 | $1,258.99 | $8,500.00 | |
Aetna
| Professional | $1,258.99 | $1,258.99 | $1,811.41 | |
Cigna
| Professional | $2,116.30 | $2,116.30 | $2,116.30 | |
Medica
| Facility | $1,258.99 | $1,258.99 | $3,776.97 |