| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $17.66 | $17.66 | $17.66 | |
Aetna
| Professional | $17.66 | $17.66 | $52.80 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $19.50 | $19.50 | $19.50 | |
Medica
| Facility | $17.66 | $22.84 | $90.90 |