| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1.00 | $1.55 | $3.02 | |
Aetna
| Professional | $1.00 | $1.00 | $1.00 | |
Cigna
| Professional | $194.98 | $194.98 | $194.98 | |
Molina
| Professional | $32.36 | $33.11 | $85.11 | |
Pacific Source
| Facility | $371.54 | $371.54 | $371.54 | |
Pacific Source
| Professional | $371.54 | $371.54 | $371.54 |