| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $22.52 | $22.52 | $47.14 | |
Aetna
| Professional | $22.52 | $28.28 | $28.28 | |
Cigna
| Professional | $47.25 | $47.25 | $59.06 | |
Medica
| Facility | $22.52 | $47.14 | $47.14 | |
Medica
| Professional | $47.14 | $47.14 | $51.20 | |
United
| Professional | $40.07 | $47.14 | $51.20 |