| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $173.00 | $173.00 | $173.00 | |
Aetna
| Professional | $173.00 | $173.00 | $173.00 | |
Cigna
| Professional | $192.01 | $192.01 | $192.01 | |
Medica
| Facility | $173.00 | $173.00 | $178.19 | |
Medica
| Professional | $614.21 | $614.21 | $614.21 | |
United
| Professional | $614.21 | $614.21 | $614.21 |