| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $307.00 | $307.00 | $307.00 | |
Aetna
| Professional | $2,017.00 | $2,017.00 | $2,017.00 | |
Cigna
| Facility | $153.69 | $315.80 | $361.79 | |
Molina
| Professional | $50.00 | $50.00 | $50.00 |