| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,607.80 | $8,591.70 | $15,255.52 | |
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 | $30.00 |