| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $14.05 | $14.05 | $14.05 | |
Aetna
| Professional | $14.05 | $14.05 | $14.05 | |
Cigna
| Facility | $10.75 | $10.75 | $10.75 | |
Cigna
| Professional | $7.85 | $7.85 | $10.75 | |
Medica
| Facility | $14.05 | $14.14 | $90.00 |