| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.75 | $30.75 | $30.75 | |
Aetna
| Professional | $30.75 | $30.75 | $30.75 | |
Cigna
| Professional | $15.75 | $24.38 | $30.47 | |
Medica
| Facility | $30.75 | $43.67 | $92.25 | |
Medica
| Professional | $24.28 | $26.71 | $26.71 | |
United
| Professional | $24.28 | $26.71 | $27.44 |