| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $107.15 | $131.83 | $158.49 | |
Aetna
| Professional | $131.83 | $131.83 | $229.09 | |
Cigna
| Facility | $27.54 | $66.07 | $169.82 | |
Medica
| Facility | $131.83 | $131.83 | $245.47 | |
Medica
| Professional | $346.74 | $346.74 | $346.74 | |
United
| Facility | $17.78 | $28.84 | $77.62 |