| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,751.72 | $1,751.72 | $1,751.72 | |
Aetna
| Professional | $1,751.72 | $1,751.72 | $2,411.21 | |
Cigna
| Professional | $1,543.12 | $1,543.12 | $1,543.12 | |
Medica
| Facility | $1,751.72 | $1,751.72 | $2,550.00 |