| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $75.00 | $75.00 | $75.00 | |
Aetna
| Professional | $75.00 | $75.00 | $75.00 | |
Cigna
| Professional | $98.27 | $98.27 | $98.27 | |
Medica
| Facility | $75.00 | $78.03 | $111.89 | |
Medica
| Professional | $188.44 | $188.44 | $188.44 |