| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $135.83 | $135.83 | $135.83 | |
Aetna
| Professional | $135.83 | $153.68 | $369.15 | |
Cigna
| Professional | $216.38 | $216.38 | $216.38 | |
Molina
| Professional | $30.00 | $45.00 | $60.00 | |
United
| Professional | $254.57 | $254.57 | $254.57 |