| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $81.97 | $81.97 | $81.97 | |
Aetna
| Professional | $40.35 | $47.58 | $81.97 | |
Cigna
| Professional | $31.50 | $31.50 | $39.38 | |
Medica
| Facility | $11.49 | $81.97 | $245.91 | |
Medica
| Professional | $117.60 | $205.67 | $303.86 | |
United
| Professional | $32.47 | $136.47 | $242.74 |