| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $21.79 | $21.79 | $21.79 | |
Aetna
| Professional | $21.79 | $21.79 | $21.79 | |
Cigna
| Professional | $174.33 | $174.33 | $174.33 | |
Molina
| Professional | $45.00 | $45.00 | $60.00 | |
United
| Professional | $126.62 | $137.29 | $195.92 |