| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $125.00 | $125.00 | $125.00 | |
Cigna
| Facility | $228.57 | $228.57 | $228.57 | |
Cigna
| Professional | $228.57 | $228.57 | $228.57 | |
Medica
| Facility | $100.00 | $100.00 | $382.70 | |
Medica
| Professional | $79.94 | $79.94 | $79.94 |