| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $144.83 | $144.83 | $288.20 | |
Aetna
| Professional | $144.83 | $144.83 | $144.83 | |
Cigna
| Facility | $151.97 | $151.97 | $151.97 | |
Cigna
| Professional | $58.14 | $151.97 | $151.97 | |
Medica
| Facility | $68.38 | $152.07 | $670.50 |