| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $72.97 | $72.97 | $72.97 | |
Aetna
| Professional | $72.97 | $72.97 | $72.97 | |
Cigna
| Professional | $136.94 | $136.94 | $136.94 | |
Molina
| Professional | $45.00 | $45.00 | $60.00 | |
United
| Professional | $79.33 | $83.51 | $83.51 |