| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $503.29 | $503.29 | $646.11 | |
Cigna
| Facility | $390.00 | $390.00 | $397.80 | |
Cigna
| Professional | $331.50 | $390.00 | $397.80 | |
Harvard Pilgrim
| Professional | $808.44 | $2,269.37 | $2,876.35 |