| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $84.75 | $84.75 | $84.75 | |
Aetna
| Professional | $23.15 | $23.15 | $84.75 | |
Cigna
| Facility | $99.00 | $99.00 | $99.00 | |
Cigna
| Professional | $50.59 | $50.59 | $50.59 | |
Molina
| Professional | $30.00 | $45.00 | $60.00 |