| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $48.75 | $48.75 | $48.75 | |
Aetna
| Professional | $48.75 | $48.75 | $48.75 | |
Cigna
| Professional | $113.48 | $286.95 | $751.00 | |
Molina
| Professional | $30.00 | $60.00 | $280.64 | |
United
| Professional | $92.92 | $92.92 | $92.92 |