| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.00 | $30.00 | $30.00 | |
Aetna
| Professional | $30.00 | $30.00 | $30.00 | |
Cigna
| Professional | $19.32 | $19.32 | $19.32 | |
Medica
| Facility | $30.00 | $30.00 | $51.00 | |
Medica
| Professional | $188.65 | $188.65 | $188.65 | |
United
| Professional | $188.65 | $188.65 | $188.65 |