| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $23.15 | $67.11 | $67.11 | |
Aetna
| Professional | $23.15 | $23.15 | $70.00 | |
Cigna
| Facility | $99.00 | $99.00 | $165.00 | |
Cigna
| Professional | $50.59 | $50.59 | $93.00 | |
Medica
| Facility | $21.99 | $23.15 | $100.00 |