| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $116.84 | $5,160.84 | $5,505.00 | |
Aetna
| Professional | $5,160.84 | $5,160.84 | $5,160.84 | |
Cigna
| Professional | $3,467.91 | $3,467.91 | $3,467.91 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |