| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $57.54 | $57.54 | $57.54 | |
Aetna
| Professional | $45.71 | $57.54 | $77.62 | |
Cigna
| Professional | $51.29 | $51.29 | $87.10 | |
Medica
| Facility | $56.23 | $70.79 | $107.15 | |
Medica
| Professional | $60.26 | $60.26 | $371.54 | |
United
| Professional | $60.26 | $60.26 | $67.61 |