| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $46.28 | $46.28 | $46.28 | |
Aetna
| Professional | $46.28 | $46.28 | $48.56 | |
Cigna
| Facility | $48.56 | $48.56 | $48.56 | |
Cigna
| Professional | $48.56 | $48.56 | $48.56 | |
Medica
| Facility | $46.28 | $48.59 | $242.65 | |
Medica
| Professional | $57.13 | $1,576.28 | $1,670.86 | |
United
| Professional | $54.27 | $57.13 | $63.00 |