| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5.01 | $5.01 | $5.01 | |
Aetna
| Professional | $5.01 | $5.01 | $5.01 | |
Cigna
| Professional | $30.90 | $30.90 | $30.90 | |
Medica
| Facility | $5.01 | $5.25 | $14.13 | |
Medica
| Professional | $251.19 | $251.19 | $251.19 |