| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $125.89 | $125.89 | $125.89 | |
Aetna
| Professional | $66.07 | $91.20 | $125.89 | |
Cigna
| Facility | $169.82 | $169.82 | $169.82 | |
Medica
| Facility | $100.00 | $100.00 | $100.00 | |
United
| Professional | $125.89 | $125.89 | $125.89 |