| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $174.10 | $174.10 | $174.10 | |
Aetna
| Professional | $174.10 | $174.10 | $174.10 | |
Cigna
| Professional | $161.72 | $161.72 | $161.72 | |
Medica
| Facility | $174.10 | $186.29 | $259.74 | |
Medica
| Professional | $690.53 | $690.53 | $690.53 |