| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $37.15 | $37.15 | $37.15 | |
Aetna
| Professional | $19.05 | $37.15 | $37.15 | |
Cigna
| Professional | $19.50 | $19.50 | $19.50 | |
Medcost
| Facility | $21.38 | $37.15 | $64.57 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |