| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $87.10 | $87.10 | $87.10 | |
Aetna
| Professional | $87.10 | $87.10 | $398.11 | |
Cigna
| Professional | $288.40 | $288.40 | $288.40 | |
Medica
| Facility | $87.10 | $91.20 | $245.47 | |
Medica
| Professional | $363.08 | $616.60 | $616.60 | |
United
| Professional | $363.08 | $363.08 | $380.19 |