| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $69.45 | $69.45 | $69.45 | |
Aetna
| Professional | $69.45 | $69.45 | $73.09 | |
Cigna
| Professional | $0.09 | $0.09 | $0.09 | |
Medica
| Facility | $65.79 | $80.31 | $178.20 | |
Medica
| Professional | $27.76 | $59.61 | $83.15 | |
United
| Professional | $27.76 | $59.61 | $83.15 |