| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $175.28 | $175.28 | $175.28 | |
Aetna
| Professional | $175.28 | $175.28 | $175.28 | |
Cigna
| Professional | $148.66 | $148.66 | $178.12 | |
Medica
| Facility | $175.28 | $182.36 | $255.70 | |
Medica
| Professional | $115.97 | $115.97 | $115.97 |