| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $14.13 | $14.13 | $14.13 | |
Aetna
| Professional | $14.13 | $14.13 | $138.04 | |
Cigna
| Professional | $131.83 | $131.83 | $131.83 | |
Medica
| Facility | $14.79 | $18.62 | $100.00 | |
United
| Facility | $56.23 | $56.23 | $60.26 |