| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $67.15 | $67.15 | $67.15 | |
Aetna
| Professional | $67.15 | $67.15 | $73.33 | |
Cigna
| Facility | $30.72 | $30.72 | $30.72 | |
Cigna
| Professional | $30.72 | $30.72 | $1,086.56 | |
Medica
| Facility | $67.15 | $67.15 | $173.57 | |
Medica
| Professional | $80.83 | $80.83 | $80.83 |