| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $215.60 | $215.60 | $554.40 | |
Aetna
| Professional | $215.60 | $289.52 | $289.52 | |
Cigna
| Professional | $353.94 | $353.94 | $519.60 | |
Medica
| Facility | $66.48 | $221.76 | $554.40 | |
Medica
| Professional | $82.69 | $202.66 | $616.00 | |
United
| Professional | $82.69 | $192.54 | $523.60 |