| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $208.54 | $208.54 | $208.54 | |
Aetna
| Professional | $177.26 | $208.54 | $208.54 | |
Cigna
| Professional | $177.26 | $177.26 | $177.26 | |
Medica
| Facility | $268.39 | $292.52 | $352.43 | |
Medica
| Professional | $792.45 | $792.45 | $792.45 |