| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $76.83 | $76.83 | $76.83 | |
Aetna
| Professional | $76.83 | $76.83 | $78.68 | |
Cigna
| Professional | $81.77 | $89.84 | $107.63 | |
Molina
| Professional | $30.00 | $95.16 | $104.02 | |
United
| Professional | $92.57 | $92.57 | $92.57 |