| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $94.74 | $94.74 | $94.74 | |
Aetna
| Professional | $78.63 | $78.63 | $94.74 | |
Cigna
| Professional | $83.63 | $84.46 | $104.53 | |
Medica
| Facility | $82.95 | $94.74 | $418.45 | |
Medica
| Professional | $37.90 | $94.74 | $104.21 | |
United
| Professional | $37.90 | $94.74 | $104.21 |