| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $137.47 | $137.47 | $137.47 | |
Aetna
| Professional | $137.47 | $137.47 | $2,929.00 | |
Cigna
| Professional | $165.00 | $165.00 | $165.00 | |
Medica
| Facility | $232.32 | $3,158.08 | $4,950.01 |