| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5,128.61 | $5,128.61 | $5,128.61 | |
Aetna
| Professional | $5,128.61 | $5,128.61 | $5,128.61 | |
Cigna
| Professional | $5,623.41 | $5,754.40 | $7,079.46 | |
Medica
| Facility | $100.00 | $7,585.78 | $9,120.11 |