| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $119.61 | $119.61 | $132.77 | |
Aetna
| Professional | $119.61 | $119.61 | $132.77 | |
Cigna
| Facility | $52.36 | $131.35 | $131.35 | |
Cigna
| Professional | $131.35 | $131.35 | $131.35 | |
Molina
| Professional | $20.00 | $20.00 | $20.00 | |
United
| Professional | $117.28 | $130.30 | $140.74 |