| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $40.00 | $40.00 | $40.00 | |
Aetna
| Professional | $40.00 | $40.00 | $40.00 | |
Cigna
| Professional | $139.72 | $139.72 | $139.72 | |
Medica
| Facility | $40.00 | $41.62 | $100.00 | |
Medica
| Professional | $110.85 | $110.85 | $110.85 |