| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $791.41 | $791.41 | $791.41 | |
Aetna
| Professional | $791.41 | $791.41 | $791.41 | |
Cigna
| Facility | $852.91 | $852.91 | $852.91 | |
Cigna
| Professional | $271.26 | $271.26 | $271.26 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |