| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $57.90 | $57.90 | $110.74 | |
Aetna
| Professional | $57.90 | $60.08 | $72.38 | |
Cigna
| Professional | $61.52 | $104.25 | $130.31 | |
Medica
| Facility | $57.90 | $82.97 | $103.18 | |
Medica
| Professional | $60.32 | $60.32 | $477.55 | |
United
| Professional | $60.32 | $60.32 | $67.56 |