| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5.01 | $5.01 | $5.01 | |
Aetna
| Professional | $5.01 | $5.01 | $100.00 | |
Cigna
| Professional | $147.91 | $147.91 | $186.21 | |
Medica
| Facility | $5.62 | $7.94 | $25.12 | |
United
| Professional | $125.89 | $125.89 | $141.25 |