| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $39.81 | $39.81 | $39.81 | |
Aetna
| Professional | $39.81 | $39.81 | $39.81 | |
Cigna
| Professional | $141.25 | $141.25 | $141.25 | |
Medica
| Facility | $39.81 | $42.66 | $107.15 | |
Medica
| Professional | $109.65 | $109.65 | $109.65 |