| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $87.10 | $87.10 | $87.10 | |
Aetna
| Professional | $63.10 | $93.33 | $131.83 | |
Cigna
| Professional | $60.26 | $60.26 | $75.86 | |
Medica
| Facility | $87.10 | $138.04 | $302.00 | |
Medica
| Professional | $41.69 | $72.44 | $213.80 | |
United
| Facility | $63.10 | $63.10 | $63.10 | |
United
| Professional | $41.69 | $63.10 | $102.33 |