| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $70.00 | $70.00 | $70.00 | |
Aetna
| Professional | $70.00 | $70.00 | $70.00 | |
Cigna
| Facility | $413.50 | $413.50 | $516.88 | |
Cigna
| Professional | $310.13 | $310.13 | $387.66 | |
Medica
| Facility | $117.81 | $118.30 | $146.72 |