| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $257.99 | $257.99 | $257.99 | |
Aetna
| Professional | $257.99 | $257.99 | $312.17 | |
Cigna
| Professional | $262.88 | $262.88 | $328.59 | |
Medica
| Facility | $257.99 | $257.99 | $438.58 | |
Medica
| Professional | $271.57 | $283.79 | $283.79 | |
United
| Professional | $257.99 | $283.79 | $291.52 |