| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $29.50 | $29.50 | $56.43 | |
Aetna
| Professional | $29.50 | $30.61 | $36.88 | |
Cigna
| Professional | $31.35 | $33.19 | $41.48 | |
Medica
| Facility | $22.63 | $29.50 | $36.88 | |
Medica
| Professional | $30.73 | $34.21 | $678.95 | |
United
| Professional | $30.73 | $30.73 | $37.15 |