| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $53.14 | $53.14 | $53.14 | |
Aetna
| Professional | $48.75 | $48.75 | $50.71 | |
Cigna
| Professional | $207.00 | $207.00 | $207.00 | |
Medica
| Facility | $48.75 | $51.19 | $136.99 | |
Medica
| Professional | $901.00 | $901.00 | $901.00 | |
United
| Professional | $542.00 | $542.00 | $542.00 |