| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,785.35 | $3,785.35 | $8,500.00 | |
Aetna
| Professional | $3,785.35 | $3,785.35 | $3,888.42 | |
Cigna
| Professional | $5,141.25 | $5,141.25 | $5,141.25 | |
Medica
| Facility | $3,785.35 | $3,785.35 | $11,356.05 |