| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $173.09 | $173.09 | $173.09 | |
Aetna
| Professional | $168.92 | $173.09 | $179.34 | |
Cigna
| Facility | $177.26 | $177.26 | $177.26 | |
Cigna
| Professional | $177.26 | $177.26 | $177.26 | |
Molina
| Professional | $45.00 | $214.36 | $234.30 |