| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $25.08 | $25.08 | $25.08 | |
Aetna
| Professional | $25.08 | $58.31 | $89.26 | |
Cigna
| Professional | $48.34 | $48.34 | $88.31 | |
Medica
| Facility | $25.08 | $41.57 | $112.30 | |
Medica
| Professional | $380.66 | $380.66 | $380.66 |