| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $74.81 | $97.56 | $97.56 | |
Aetna
| Professional | $21.00 | $93.52 | $97.56 | |
Cigna
| Facility | $33.56 | $41.37 | $137.93 | |
Cigna
| Professional | $62.78 | $62.78 | $78.47 | |
Medica
| Facility | $23.55 | $97.56 | $117.42 |