| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $19.05 | $19.05 | $19.05 | |
Aetna
| Professional | $19.05 | $19.05 | $22.91 | |
Cigna
| Facility | $15.85 | $15.85 | $15.85 | |
Medica
| Facility | $19.05 | $22.39 | $57.54 | |
Medica
| Professional | $91.20 | $91.20 | $91.20 | |
United
| Facility | $10.23 | $10.23 | $10.23 |