| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $318.22 | $1,661.70 | $6,147.49 | |
Aetna
| Professional | $318.22 | $318.22 | $6,277.99 | |
Cigna
| Professional | $673.84 | $673.84 | $673.84 | |
Medica
| Facility | $318.22 | $525.05 | $604.62 |