| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $166.83 | $166.83 | $166.83 | |
Aetna
| Professional | $166.83 | $173.09 | $208.54 | |
Cigna
| Professional | $177.26 | $177.26 | $177.26 | |
Medica
| Facility | $166.83 | $166.83 | $283.61 | |
Medica
| Professional | $792.45 | $792.45 | $792.45 |