| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $25.12 | $25.12 | $25.12 | |
Aetna
| Professional | $25.12 | $25.12 | $25.12 | |
Cigna
| Facility | $33.11 | $33.11 | $33.11 | |
Cigna
| Professional | $23.99 | $23.99 | $33.11 | |
Molina
| Professional | $30.20 | $44.67 | $60.26 | |
United
| Facility | $25.12 | $25.12 | $25.12 | |
United
| Professional | $128.82 | $128.82 | $128.82 |