| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $687.45 | $960.36 | $1,145.06 | |
Aetna
| Professional | $1,145.06 | $1,145.06 | $1,145.06 | |
Cigna
| Facility | $1,197.46 | $1,197.46 | $1,197.46 | |
Cigna
| Professional | $520.86 | $520.86 | $520.86 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |