| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $146.62 | $214.56 | $214.56 | |
Aetna
| Professional | $146.62 | $151.97 | $214.56 | |
Cigna
| Facility | $151.97 | $151.97 | $151.97 | |
Cigna
| Professional | $151.97 | $151.97 | $151.97 | |
Molina
| Professional | $17.00 | $17.00 | $20.00 |