| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $239.87 | $299.83 | $299.83 | |
Aetna
| Professional | $299.83 | $299.83 | $365.38 | |
Cigna
| Facility | $33.56 | $35.31 | $143.65 | |
Cigna
| Professional | $109.45 | $109.45 | $136.81 | |
Medica
| Facility | $269.86 | $299.83 | $400.00 |