| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $47.50 | $47.50 | $52.67 | |
Cigna
| Professional | $29.52 | $29.52 | $29.52 | |
Medica
| Facility | $50.00 | $72.50 | $104.00 | |
Medica
| Professional | $42.50 | $52.51 | $89.64 | |
United
| Professional | $42.50 | $55.00 | $89.64 |