| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $574.00 | $574.00 | $574.00 | |
Cigna
| Facility | $424.00 | $424.00 | $424.00 | |
Cigna
| Professional | $360.40 | $424.00 | $457.97 | |
Medica
| Facility | $574.00 | $574.00 | $688.80 | |
Medica
| Professional | $574.00 | $574.00 | $574.00 |