| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $287.22 | $287.22 | $287.22 | |
Cigna
| Facility | $180.13 | $180.13 | $180.13 | |
Cigna
| Professional | $153.11 | $180.13 | $180.13 | |
Molina
| Professional | $60.00 | $120.81 | $209.40 |