| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $517.29 | $517.29 | $646.63 | |
Aetna
| Professional | $517.29 | $550.00 | $550.00 | |
Cigna
| Facility | $99.01 | $99.01 | $99.01 | |
Molina
| Professional | $60.00 | $85.00 | $1,500.00 | |
Providence
| Facility | $99.01 | $99.01 | $550.00 |