| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3.44 | $3.44 | $3.44 | |
Aetna
| Professional | $3.44 | $3.44 | $3.44 | |
Cigna
| Professional | $119.56 | $119.56 | $119.56 | |
Medica
| Facility | $3.44 | $3.96 | $100.00 | |
United
| Facility | $89.46 | $89.46 | $148.50 |