| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $170.09 | $170.09 | $382.70 | |
Aetna
| Professional | $170.09 | $212.61 | $212.61 | |
Cigna
| Professional | $186.38 | $186.38 | $232.97 | |
Medica
| Facility | $170.09 | $212.61 | $289.14 | |
Medica
| Professional | $180.30 | $180.30 | $195.81 | |
United
| Professional | $153.26 | $180.30 | $201.94 |