| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,485.00 | $1,485.00 | $1,485.00 | |
Aetna
| Professional | $1,188.00 | $1,188.00 | $1,485.00 | |
Cigna
| Professional | $1,262.25 | $1,262.25 | $1,670.63 | |
Medica
| Facility | $6,558.75 | $6,558.75 | $6,558.75 |