| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $831.76 | $831.76 | $831.76 | |
Aetna
| Professional | $831.76 | $831.76 | $831.76 | |
Cigna
| Professional | $190.55 | $190.55 | $229.09 | |
Medica
| Facility | $831.76 | $831.76 | $1,122.02 | |
Medica
| Professional | $75.86 | $75.86 | $75.86 |