| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $111.77 | $111.77 | $111.77 | |
Aetna
| Professional | $29.08 | $111.77 | $122.64 | |
Cigna
| Professional | $79.90 | $133.62 | $184.08 | |
Medica
| Facility | $111.77 | $119.81 | $169.22 | |
Medica
| Professional | $100.84 | $125.56 | $257.68 | |
United
| Professional | $99.37 | $122.40 | $173.51 |