| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $243.71 | $243.71 | $243.71 | |
Cigna
| Facility | $170.83 | $170.83 | $170.83 | |
Cigna
| Professional | $145.21 | $170.83 | $170.83 | |
Molina
| Professional | $60.00 | $120.81 | $209.40 |