| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $28.52 | $28.52 | $28.52 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $1,426.43 | $1,426.43 | $1,426.43 | |
Medcost
| Facility | $28.52 | $28.52 | $53.96 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |