| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $171.52 | $171.52 | $171.52 | |
Aetna
| Professional | $171.52 | $177.95 | $214.40 | |
Cigna
| Professional | $182.24 | $182.24 | $182.24 | |
Medica
| Facility | $171.52 | $171.52 | $291.58 | |
Medica
| Professional | $814.72 | $814.72 | $814.72 |