| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $68.13 | $68.13 | $68.13 | |
Aetna
| Professional | $68.13 | $68.13 | $68.13 | |
Cigna
| Professional | $35.29 | $35.29 | $50.00 | |
Medica
| Facility | $68.13 | $68.13 | $119.23 | |
Medica
| Professional | $96.53 | $96.53 | $96.53 |