| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $131.82 | $131.82 | $131.82 | |
Aetna
| Professional | $105.46 | $105.46 | $131.82 | |
Cigna
| Facility | $40.00 | $40.00 | $112.05 | |
Cigna
| Professional | $112.05 | $112.05 | $112.05 | |
Medica
| Facility | $105.46 | $123.39 | $296.33 | |
Medica
| Professional | $486.29 | $486.29 | $486.29 |