| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $307.00 | $307.00 | $307.00 | |
Aetna
| Professional | $1,059.21 | $1,059.21 | $1,059.21 | |
Cigna
| Facility | $630.00 | $630.00 | $630.00 | |
Molina
| Professional | $40.00 | $40.00 | $50.00 | |
Wellpoint
| Professional | $353.56 | $353.56 | $353.56 |