| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $37.15 | $37.15 | $37.15 | |
Aetna
| Professional | $28.84 | $29.51 | $37.15 | |
Cigna
| Facility | $1,202.26 | $1,202.26 | $1,202.26 | |
Cigna
| Professional | $870.96 | $870.96 | $870.96 | |
Molina
| Professional | $32.36 | $39.81 | $50.12 | |
Wellpoint
| Professional | $346.74 | $346.74 | $346.74 |