| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $55.59 | $55.59 | $55.59 | |
Aetna
| Professional | $55.59 | $61.60 | $71.31 | |
Cigna
| Professional | $165.04 | $165.04 | $165.04 | |
Medica
| Facility | $55.59 | $58.37 | $87.19 | |
Medica
| Professional | $61.97 | $82.11 | $432.44 | |
United
| Professional | $61.97 | $74.15 | $138.22 |