| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $69.50 | $69.50 | $69.50 | |
Cigna
| Facility | $64.17 | $64.17 | $64.17 | |
Cigna
| Professional | $13.43 | $64.17 | $202.50 | |
Molina
| Professional | $62.37 | $110.00 | $174.39 | |
United
| Professional | $69.50 | $72.31 | $154.44 |