| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,545.58 | $1,545.58 | $4,102.39 | |
Aetna
| Professional | $1,545.58 | $1,545.58 | $1,545.58 | |
Cigna
| Professional | $660.66 | $660.66 | $660.66 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |