| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $104.69 | $104.69 | $104.69 | |
Aetna
| Professional | $104.69 | $104.69 | $104.69 | |
Cigna
| Facility | $66.00 | $66.00 | $77.00 | |
Medica
| Facility | $104.69 | $107.83 | $178.60 | |
Medica
| Professional | $270.97 | $270.97 | $270.97 |