| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $52.25 | $52.25 | $52.25 | |
Aetna
| Professional | $51.83 | $52.65 | $59.51 | |
Cigna
| Professional | $50.86 | $50.86 | $50.86 | |
Medica
| Facility | $52.25 | $56.95 | $84.24 | |
Medica
| Professional | $60.55 | $60.55 | $368.87 | |
United
| Professional | $60.55 | $60.55 | $63.64 |