| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $176.54 | $176.54 | $176.54 | |
Aetna
| Professional | $176.54 | $183.16 | $220.67 | |
Cigna
| Facility | $88.56 | $88.56 | $101.85 | |
Cigna
| Professional | $187.57 | $187.57 | $187.57 | |
Medica
| Facility | $176.54 | $176.54 | $300.12 | |
Medica
| Professional | $790.40 | $790.40 | $790.40 |