| 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 | $512.86 | $630.96 | |
Medica
| Facility | $39.81 | $60.26 | $79.43 | |
Medica
| Professional | $109.65 | $109.65 | $117.49 |