| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $29.56 | $29.56 | $29.56 | |
Aetna
| Professional | $14.66 | $14.66 | $29.56 | |
Cigna
| Professional | $19.88 | $24.84 | $25.24 | |
Medica
| Facility | $14.66 | $24.78 | $49.96 | |
United
| Professional | $1.00 | $1.00 | $1.00 |