| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $78.63 | $78.63 | $78.63 | |
Cigna
| Facility | $80.53 | $80.53 | $83.69 | |
Cigna
| Professional | $80.53 | $83.69 | $83.69 | |
Medica
| Facility | $80.53 | $94.74 | $418.45 | |
Medica
| Professional | $66.31 | $94.74 | $94.74 | |
United
| Professional | $61.58 | $94.74 | $94.74 |