| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $157.00 | $157.00 | $157.00 | |
Aetna
| Professional | $8.00 | $157.00 | $157.00 | |
Cigna
| Facility | $50.50 | $50.50 | $63.13 | |
Cigna
| Professional | $33.75 | $33.75 | $42.19 | |
Medica
| Facility | $26.53 | $35.06 | $265.33 |