| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $4.87 | $4.87 | $4.87 | |
Cigna
| Professional | $4.87 | $4.87 | $4.87 | |
Medica
| Facility | $0.39 | $5.73 | $455.75 | |
Medica
| Professional | $5.73 | $5.73 | $5.73 | |
United
| Professional | $5.73 | $5.73 | $5.73 |