| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $20.83 | $20.83 | $20.83 | |
Aetna
| Professional | $20.83 | $20.83 | $29.28 | |
Cigna
| Facility | $65.00 | $70.00 | $80.00 | |
Molina
| Professional | $32.34 | $60.00 | $1,500.00 | |
Providence
| Facility | $20.83 | $65.00 | $75.00 |