| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $707.95 | $707.95 | $707.95 | |
Aetna
| Professional | $707.95 | $707.95 | $1,348.96 | |
Cigna
| Professional | $1,230.27 | $1,230.27 | $1,513.56 | |
Medica
| Facility | $707.95 | $707.95 | $1,174.90 |