| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $630.96 | $630.96 | $630.96 | |
Cigna
| Facility | $1,047.13 | $1,047.13 | $1,047.13 | |
Cigna
| Professional | $891.25 | $891.25 | $1,047.13 | |
Priority Health
| Facility | $1,047.13 | $1,047.13 | $1,047.13 | |
Priority Health
| Professional | $891.25 | $1,047.13 | $1,047.13 |