| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $16.29 | $16.29 | $16.29 | |
Aetna
| Professional | $16.29 | $16.29 | $16.29 | |
Cigna
| Professional | $281.33 | $281.33 | $281.33 | |
Medica
| Facility | $16.29 | $17.76 | $26.06 | |
Medica
| Professional | $244.14 | $244.14 | $244.14 |