| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,726.72 | $1,726.72 | $3,135.93 | |
Aetna
| Professional | $1,726.72 | $1,726.72 | $3,135.93 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Molina
| Professional | $40.00 | $40.00 | $40.00 | |
Wellpoint
| Professional | $16.00 | $16.00 | $16.00 |