| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $49.91 | $49.91 | $49.91 | |
Cigna
| Facility | $1,300.00 | $1,300.00 | $1,300.00 | |
Cigna
| Professional | $1,105.00 | $1,300.00 | $1,300.00 | |
Hally Health
| Professional | $100.00 | $100.00 | $200.00 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |