| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $65.84 | $65.84 | $353.21 | |
Aetna
| Professional | $30.10 | $63.36 | $71.20 | |
Cigna
| Facility | $175.95 | $175.95 | $175.95 | |
Cigna
| Professional | $52.37 | $220.76 | $379.81 | |
Medica
| Facility | $69.66 | $133.49 | $353.21 | |
Medica
| Professional | $620.54 | $620.54 | $620.54 |