| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $626.08 | $1,242.35 | $1,242.35 | |
Aetna
| Professional | $9.74 | $38.59 | $2,673.50 | |
Cigna
| Professional | $125.40 | $125.40 | $125.40 | |
Molina
| Professional | $17.00 | $20.00 | $25.00 |