| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $129.50 | $129.50 | $129.50 | |
Aetna
| Professional | $65.55 | $129.50 | $213.50 | |
Cigna
| Professional | $68.73 | $68.73 | $68.73 | |
Molina
| Professional | $17.00 | $25.00 | $50.00 | |
United
| Professional | $79.90 | $106.20 | $163.44 |