| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $97.00 | $97.00 | $97.00 | |
Aetna
| Professional | $97.00 | $97.00 | $97.00 | |
Cigna
| Facility | $94.60 | $94.60 | $94.60 | |
Cigna
| Professional | $94.60 | $94.60 | $94.60 | |
Medica
| Facility | $97.00 | $97.00 | $169.75 |