| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $531.89 | $531.89 | $1,552.95 | |
Aetna
| Professional | $531.89 | $531.89 | $531.89 | |
Cigna
| Facility | $1,197.46 | $1,197.46 | $1,197.46 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |