| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $166.60 | $166.60 | $428.40 | |
Aetna
| Professional | $166.60 | $223.72 | $223.72 | |
Cigna
| Professional | $273.41 | $273.41 | $401.37 | |
Medica
| Facility | $142.80 | $171.36 | $428.40 | |
Medica
| Professional | $82.91 | $203.21 | $476.00 | |
United
| Professional | $82.91 | $203.21 | $404.60 |