| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $112.68 | $112.68 | $112.68 | |
Cigna
| Professional | $449.45 | $449.45 | $449.45 | |
Medica
| Facility | $27.28 | $112.68 | $112.68 | |
Medica
| Professional | $108.39 | $108.39 | $108.39 |