| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $21.26 | $21.26 | $21.79 | |
Cigna
| Facility | $174.33 | $174.33 | $174.33 | |
Cigna
| Professional | $174.33 | $174.33 | $174.33 | |
Medica
| Facility | $21.53 | $219.95 | $1,122.17 | |
Medica
| Professional | $123.05 | $169.20 | $344.67 | |
United
| Professional | $91.52 | $137.29 | $244.90 |