| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $57.87 | $57.87 | $57.87 | |
Aetna
| Professional | $57.87 | $57.87 | $60.92 | |
Cigna
| Professional | $56.91 | $56.91 | $56.91 | |
Medica
| Facility | $54.83 | $63.97 | $141.22 | |
Medica
| Professional | $23.14 | $49.66 | $69.26 | |
United
| Professional | $23.14 | $52.26 | $69.26 |