| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $80.00 | $96.00 | $172.80 | |
Aetna
| Professional | $80.00 | $80.00 | $80.00 | |
Cigna
| Facility | $61.58 | $143.86 | $451.85 | |
Medica
| Facility | $94.96 | $94.96 | $148.38 | |
Medica
| Professional | $145.41 | $145.41 | $145.41 |