| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $29.74 | $29.74 | $29.74 | |
Aetna
| Professional | $29.74 | $29.74 | $37.17 | |
Cigna
| Professional | $872.98 | $872.98 | $872.98 | |
Medica
| Facility | $29.74 | $32.71 | $62.93 | |
Medica
| Professional | $37.17 | $37.17 | $37.17 |