| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $206.70 | $206.70 | $206.70 | |
Cigna
| Professional | $158.77 | $206.70 | $206.70 | |
Medica
| Facility | $203.58 | $206.70 | $744.30 | |
Medica
| Professional | $234.00 | $234.00 | $234.00 | |
United
| Professional | $234.00 | $234.00 | $234.00 |