| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $25.70 | $2,398.83 | $4,677.35 | |
Aetna
| Professional | $123.03 | $138.04 | $724.44 | |
Cigna
| Professional | $165.96 | $165.96 | $165.96 | |
Molina
| Professional | $30.20 | $44.67 | $75.86 |