| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $23.78 | $23.78 | $23.78 | |
Aetna
| Professional | $19.02 | $19.02 | $23.78 | |
Cigna
| Facility | $16.00 | $16.00 | $16.00 | |
Medica
| Facility | $19.02 | $22.25 | $53.45 | |
Medica
| Professional | $90.36 | $90.36 | $90.36 |