| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $25.48 | $25.48 | $25.48 | |
Aetna
| Professional | $20.38 | $20.38 | $25.48 | |
Cigna
| Facility | $16.00 | $16.00 | $17.00 | |
Medica
| Facility | $20.38 | $23.84 | $57.27 | |
Medica
| Professional | $96.82 | $96.82 | $96.82 |