| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $50.43 | $50.43 | $50.43 | |
Aetna
| Professional | $26.75 | $31.57 | $50.43 | |
Cigna
| Professional | $15.75 | $15.75 | $19.69 | |
Medica
| Facility | $11.49 | $50.43 | $151.29 | |
Medica
| Professional | $72.34 | $126.51 | $186.93 | |
United
| Professional | $16.25 | $89.30 | $186.93 |