| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $64.76 | $64.76 | $64.76 | |
Aetna
| Professional | $64.76 | $67.19 | $80.95 | |
Cigna
| Professional | $68.81 | $68.81 | $68.81 | |
Medica
| Facility | $64.76 | $64.76 | $110.09 | |
Medica
| Professional | $325.32 | $325.32 | $325.32 |