| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $90.00 | $90.00 | $90.00 | |
Aetna
| Professional | $90.00 | $90.00 | $90.00 | |
Cigna
| Facility | $886.24 | $886.24 | $1,019.17 | |
Cigna
| Professional | $506.25 | $511.31 | $632.80 | |
Medica
| Facility | $90.00 | $90.00 | $153.00 |