| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $77.33 | $77.33 | $77.33 | |
Cigna
| Facility | $129.12 | $129.12 | $131.69 | |
Cigna
| Professional | $109.75 | $129.12 | $202.50 | |
Molina
| Professional | $60.00 | $103.80 | $164.16 | |
United
| Professional | $77.33 | $80.33 | $171.85 |