| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3.98 | $3.98 | $3.98 | |
Aetna
| Professional | $3.98 | $3.98 | $3.98 | |
Cigna
| Professional | $1.32 | $1.32 | $1.32 | |
Medica
| Facility | $3.98 | $4.17 | $89.13 | |
Medica
| Professional | $81.28 | $81.28 | $81.28 |