| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $173.00 | $173.00 | $173.00 | |
Aetna
| Professional | $173.00 | $173.00 | $173.00 | |
Cigna
| Facility | $263.02 | $263.02 | $263.02 | |
Cigna
| Professional | $263.02 | $263.02 | $263.02 | |
Medica
| Facility | $161.19 | $173.00 | $302.75 | |
Medica
| Professional | $173.00 | $173.00 | $173.00 | |
Midlands
| Facility | $1,266.63 | $1,266.63 | $1,266.63 | |
Midlands
| Professional | $51.28 | $51.28 | $1,266.63 |