| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $42.90 | $42.90 | $42.90 | |
Aetna
| Professional | $42.90 | $42.90 | $47.19 | |
Cigna
| Professional | $42.75 | $43.18 | $53.44 | |
Medica
| Facility | $42.90 | $69.39 | $128.69 | |
Medica
| Professional | $50.47 | $55.52 | $55.52 | |
United
| Professional | $50.47 | $55.52 | $57.03 |