| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $306.58 | $306.58 | $306.58 | |
Cigna
| Facility | $687.90 | $687.90 | $687.90 | |
Cigna
| Professional | $76.87 | $687.90 | $1,188.75 | |
Molina
| Professional | $60.00 | $60.00 | $60.00 | |
United
| Professional | $288.20 | $471.40 | $617.39 |