| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $21.08 | $21.08 | $21.08 | |
Aetna
| Professional | $21.08 | $21.46 | $26.82 | |
Cigna
| Professional | $32.44 | $32.44 | $32.44 | |
Medica
| Facility | $21.08 | $26.82 | $70.45 | |
Medica
| Professional | $13.87 | $21.15 | $199.29 | |
United
| Professional | $13.87 | $21.15 | $34.68 |