| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $106.77 | $106.77 | $1,980.00 | |
Aetna
| Professional | $106.77 | $106.77 | $108.09 | |
Cigna
| Facility | $112.05 | $112.05 | $112.05 | |
Cigna
| Professional | $112.05 | $112.05 | $112.05 | |
Medica
| Facility | $106.77 | $112.05 | $133.46 | |
Medica
| Professional | $486.29 | $486.29 | $486.29 |