| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $17.52 | $17.52 | $17.52 | |
Aetna
| Professional | $17.52 | $17.52 | $17.73 | |
Cigna
| Facility | $18.39 | $18.39 | $18.39 | |
Cigna
| Professional | $18.39 | $18.39 | $18.39 | |
Medica
| Facility | $17.52 | $18.39 | $80.00 | |
Medica
| Professional | $82.19 | $82.19 | $82.19 |