| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $77.59 | $77.59 | $77.59 | |
Cigna
| Facility | $174.27 | $174.27 | $174.27 | |
Cigna
| Professional | $19.86 | $174.27 | $307.50 | |
Molina
| Professional | $86.90 | $153.25 | $242.97 | |
United
| Professional | $77.59 | $116.71 | $172.42 |