| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $59.27 | $59.27 | $252.00 | |
Aetna
| Professional | $59.27 | $68.13 | $88.72 | |
Cigna
| Professional | $35.29 | $35.29 | $35.29 | |
Molina
| Professional | $40.00 | $40.00 | $50.00 | |
Wellpoint
| Professional | $3,250.00 | $3,250.00 | $3,250.00 |