| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $220.67 | $220.67 | $220.67 | |
Aetna
| Professional | $176.54 | $176.54 | $220.67 | |
Cigna
| Facility | $168.13 | $196.37 | $319.00 | |
Cigna
| Professional | $187.57 | $187.57 | $187.57 | |
Medica
| Facility | $176.54 | $203.53 | $496.08 | |
Medica
| Professional | $790.40 | $790.40 | $790.40 |