| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $15.14 | $15.14 | $15.14 | |
Cigna
| Facility | $64.57 | $64.57 | $64.57 | |
Cigna
| Professional | $1.70 | $1.70 | $1.70 | |
Medcost
| Facility | $15.14 | $15.14 | $26.92 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |