| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $62.20 | $62.20 | $62.20 | |
Aetna
| Professional | $62.20 | $62.20 | $102.00 | |
Cigna
| Professional | $93.13 | $93.13 | $93.13 | |
Medica
| Facility | $104.09 | $172.38 | $279.48 | |
Medica
| Professional | $91.30 | $91.30 | $383.50 | |
United
| Professional | $91.30 | $91.30 | $100.43 |