| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $109.41 | $109.41 | $109.41 | |
Aetna
| Professional | $106.77 | $109.41 | $113.37 | |
Cigna
| Facility | $112.05 | $112.05 | $112.05 | |
Cigna
| Professional | $112.05 | $112.05 | $112.05 | |
Molina
| Professional | $39.06 | $39.06 | $42.70 |