| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $21.63 | $21.63 | $21.63 | |
Aetna
| Professional | $18.39 | $21.63 | $21.63 | |
Cigna
| Professional | $18.39 | $18.39 | $18.39 | |
Medica
| Facility | $29.12 | $32.90 | $38.94 | |
Medica
| Professional | $82.19 | $82.19 | $82.19 |