| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $140.88 | $140.88 | $213.16 | |
Aetna
| Professional | $130.76 | $140.88 | $167.09 | |
Cigna
| Professional | $286.13 | $288.99 | $363.38 | |
Medica
| Facility | $127.72 | $140.88 | $247.37 | |
Medica
| Professional | $661.43 | $661.43 | $661.43 |