| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $425.00 | $425.00 | $425.00 | |
Aetna
| Professional | $425.00 | $425.00 | $475.00 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Medica
| Facility | $425.00 | $425.00 | $743.75 | |
Medica
| Professional | $192.00 | $192.00 | $192.00 |