| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $133.41 | $133.41 | $133.41 | |
Aetna
| Professional | $133.41 | $180.22 | $362.58 | |
Cigna
| Professional | $160.94 | $160.94 | $160.94 | |
Molina
| Professional | $30.00 | $45.00 | $60.00 | |
United
| Professional | $107.50 | $144.59 | $240.98 |