| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $72.98 | $72.98 | $72.98 | |
Aetna
| Professional | $12.46 | $30.54 | $72.98 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $150.94 | $150.94 | $150.94 | |
Medica
| Facility | $30.54 | $72.98 | $80.29 |