| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $154.34 | $154.34 | $154.34 | |
Cigna
| Professional | $81.59 | $81.59 | $81.59 | |
Molina
| Professional | $40.00 | $40.00 | $40.00 | |
Wellpoint
| Professional | $53.00 | $53.00 | $53.00 |