| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $661.06 | $1,236.08 | $2,768.22 | |
Aetna
| Professional | $137.47 | $137.47 | $137.47 | |
Cigna
| Professional | $165.00 | $165.00 | $165.00 | |
Medica
| Facility | $137.47 | $141.59 | $192.46 | |
Medica
| Professional | $54.63 | $54.63 | $54.63 |