| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $146.38 | $147.47 | $147.47 | |
Cigna
| Professional | $204.00 | $206.04 | $259.08 | |
Medica
| Facility | $146.38 | $147.47 | $176.06 | |
Medica
| Professional | $70.14 | $73.20 | $1,792.13 | |
United
| Professional | $68.77 | $70.14 | $176.06 |