| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1.26 | $1.26 | $1.26 | |
Aetna
| Professional | $1.26 | $1.26 | $1.26 | |
Cigna
| Professional | $191.26 | $191.26 | $191.26 | |
Medica
| Facility | $1.26 | $1.31 | $3.54 | |
Medica
| Professional | $322.91 | $322.91 | $322.91 |