| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $323.59 | $323.59 | $323.59 | |
Aetna
| Professional | $323.59 | $323.59 | $389.05 | |
Cigna
| Facility | $64.57 | $64.57 | $64.57 | |
Cigna
| Professional | $309.03 | $309.03 | $309.03 | |
Molina
| Professional | $50.12 | $50.12 | $79.43 |