| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $8,057.17 | $8,057.17 | $8,057.17 | |
Cigna
| Facility | $699.00 | $699.00 | $699.00 | |
Cigna
| Professional | $662.70 | $662.70 | $662.70 | |
Harvard Pilgrim
| Professional | $14,554.18 | $14,554.18 | $14,554.18 |