| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $169.82 | $213.80 | $213.80 | |
Aetna
| Professional | $169.82 | $177.83 | $213.80 | |
Cigna
| Professional | $181.97 | $181.97 | $181.97 | |
Medica
| Facility | $194.98 | $288.40 | $363.08 | |
Medica
| Professional | $812.83 | $812.83 | $812.83 |