| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $18.23 | $18.23 | $18.23 | |
Aetna
| Professional | $18.23 | $18.92 | $22.80 | |
Cigna
| Professional | $19.38 | $19.38 | $19.38 | |
Medica
| Facility | $18.23 | $18.23 | $31.92 | |
Medica
| Professional | $86.64 | $86.64 | $86.64 |