| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $16.98 | $20.89 | $20.89 | |
Aetna
| Professional | $16.98 | $16.98 | $20.89 | |
Cigna
| Professional | $18.20 | $18.20 | $18.20 | |
Medica
| Facility | $19.50 | $29.51 | $38.90 | |
Medica
| Professional | $81.28 | $81.28 | $81.28 |