| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $43.32 | $43.32 | $86.21 | |
Aetna
| Professional | $43.32 | $43.32 | $43.32 | |
Cigna
| Facility | $45.46 | $45.46 | $45.46 | |
Cigna
| Professional | $45.46 | $45.46 | $45.46 | |
Medica
| Facility | $43.32 | $45.49 | $236.20 |