| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $37.15 | $37.15 | $37.15 | |
Aetna
| Professional | $31.22 | $37.15 | $37.15 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $19.36 | $19.36 | $19.36 | |
Medcost
| Facility | $24.11 | $40.88 | $78.63 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |