| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $129.96 | $129.96 | $129.96 | |
Aetna
| Professional | $129.96 | $145.37 | $165.40 | |
Cigna
| Professional | $216.38 | $216.38 | $216.38 | |
Medica
| Facility | $129.96 | $165.40 | $468.65 | |
Medica
| Professional | $254.57 | $254.57 | $1,351.44 | |
United
| Professional | $254.57 | $254.57 | $280.70 |