| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $181.71 | $181.71 | $181.71 | |
Cigna
| Facility | $407.81 | $407.81 | $407.81 | |
Cigna
| Professional | $47.24 | $407.81 | $652.50 | |
Molina
| Professional | $60.00 | $60.00 | $60.00 | |
United
| Professional | $170.71 | $279.33 | $366.02 |