| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $336.05 | $336.05 | $336.05 | |
Aetna
| Professional | $336.05 | $336.05 | $695.78 | |
Cigna
| Facility | $405.00 | $405.00 | $405.00 | |
Cigna
| Professional | $405.00 | $405.00 | $937.50 | |
Medica
| Facility | $336.05 | $336.05 | $695.78 | |
Medica
| Professional | $673.50 | $673.50 | $673.50 |