| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5.00 | $5.00 | $5.00 | |
Aetna
| Professional | $5.00 | $5.00 | $5.00 | |
Cigna
| Professional | $31.24 | $31.24 | $31.24 | |
Medica
| Facility | $5.00 | $5.20 | $14.05 | |
Medica
| Professional | $253.44 | $253.44 | $253.44 |