| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $24.95 | $24.95 | $24.95 | |
Cigna
| Facility | $27.68 | $27.68 | $27.68 | |
Cigna
| Professional | $27.68 | $27.68 | $27.68 | |
Medica
| Facility | $24.95 | $29.94 | $45.68 | |
Medica
| Professional | $29.35 | $33.17 | $35.22 | |
United
| Professional | $29.35 | $33.17 | $35.22 |