| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $157.00 | $157.00 | $157.00 | |
Aetna
| Professional | $157.00 | $157.00 | $157.00 | |
Cigna
| Professional | $24.99 | $24.99 | $24.99 | |
Medica
| Facility | $157.00 | $161.71 | $219.80 | |
Medica
| Professional | $242.05 | $242.05 | $242.05 |