| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $125.89 | $125.89 | $125.89 | |
Aetna
| Professional | $125.89 | $125.89 | $138.04 | |
Cigna
| Professional | $123.03 | $123.03 | $154.88 | |
Medica
| Facility | $125.89 | $125.89 | $380.19 | |
Medica
| Professional | $147.91 | $162.18 | $162.18 | |
United
| Professional | $147.91 | $162.18 | $162.18 |