| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $108.51 | $108.51 | $108.51 | |
Aetna
| Professional | $98.36 | $106.91 | $108.51 | |
Cigna
| Professional | $147.91 | $147.91 | $147.91 | |
Medica
| Facility | $106.91 | $112.26 | $551.57 | |
Medica
| Professional | $174.02 | $342.87 | $923.86 | |
United
| Professional | $342.87 | $342.87 | $378.08 |