| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $25.70 | $25.70 | $25.70 | |
Aetna
| Professional | $25.70 | $25.70 | $25.70 | |
Cigna
| Professional | $147.91 | $147.91 | $186.21 | |
Medica
| Facility | $25.70 | $25.70 | $64.57 | |
United
| Professional | $125.89 | $125.89 | $141.25 |