| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $68.58 | $68.58 | $68.58 | |
Cigna
| Facility | $153.77 | $153.77 | $153.77 | |
Cigna
| Professional | $18.44 | $153.77 | $288.75 | |
Molina
| Professional | $60.00 | $60.00 | $60.00 | |
United
| Professional | $79.64 | $105.46 | $170.63 |