| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $124.50 | $124.50 | $124.50 | |
Aetna
| Professional | $121.50 | $124.50 | $129.00 | |
Cigna
| Facility | $127.50 | $127.50 | $127.50 | |
Cigna
| Professional | $127.50 | $127.50 | $127.50 | |
Molina
| Professional | $30.00 | $45.00 | $60.00 | |
United
| Professional | $150.00 | $150.00 | $150.00 |