| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $25.48 | $25.48 | $25.48 | |
Aetna
| Professional | $21.66 | $25.48 | $25.48 | |
Cigna
| Facility | $19.60 | $19.60 | $19.60 | |
Medica
| Facility | $20.20 | $38.75 | $45.86 | |
Medica
| Professional | $96.82 | $96.82 | $96.82 |