| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $58.88 | $58.88 | $58.88 | |
Aetna
| Professional | $58.88 | $58.88 | $58.88 | |
Cigna
| Facility | $524.81 | $524.81 | $524.81 | |
Cigna
| Professional | $125.89 | $446.68 | $524.81 | |
Hally Health
| Professional | $100.00 | $199.53 | $199.53 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |