| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $39.36 | $39.36 | $88.58 | |
Aetna
| Professional | $39.36 | $49.21 | $49.21 | |
Cigna
| Professional | $26.63 | $26.89 | $33.28 | |
Medica
| Facility | $39.36 | $42.32 | $95.00 | |
Medica
| Professional | $28.58 | $71.44 | $78.58 | |
United
| Professional | $28.58 | $71.44 | $80.01 |