| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $141.25 | $141.25 | $141.25 | |
Aetna
| Professional | $141.25 | $141.25 | $141.25 | |
Cigna
| Professional | $132.75 | $134.08 | $165.94 | |
Medica
| Facility | $141.25 | $141.25 | $423.75 | |
Medica
| Professional | $158.96 | $174.86 | $174.86 | |
United
| Professional | $158.96 | $174.86 | $179.62 |