| 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
| Facility | $407.59 | $407.59 | $468.72 | |
Cigna
| Professional | $232.88 | $291.08 | $295.75 | |
Medica
| Facility | $29.74 | $29.74 | $50.56 |