| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $20.83 | $20.83 | $20.83 | |
Aetna
| Professional | $20.83 | $20.83 | $20.83 | |
Cigna
| Facility | $55.00 | $65.00 | $88.00 | |
Medica
| Facility | $20.83 | $20.83 | $100.00 | |
Medica
| Professional | $272.97 | $272.97 | $272.97 |