| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $37.11 | $37.11 | $37.11 | |
Aetna
| Professional | $37.11 | $37.11 | $69.08 | |
Cigna
| Professional | $87.75 | $87.75 | $109.69 | |
Medica
| Facility | $37.11 | $63.09 | $111.33 | |
Medica
| Professional | $57.75 | $98.58 | $127.31 | |
United
| Professional | $59.29 | $105.00 | $127.31 |