| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $29.92 | $29.92 | $29.92 | |
Aetna
| Professional | $29.92 | $29.92 | $31.49 | |
Cigna
| Professional | $16.14 | $16.14 | $16.14 | |
Medica
| Facility | $28.34 | $35.96 | $81.95 | |
Medica
| Professional | $11.96 | $25.66 | $35.79 | |
United
| Professional | $11.96 | $25.66 | $35.79 |