| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $254.94 | $254.94 | $254.94 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $11.30 | $11.30 | $11.30 | |
Medcost
| Facility | $19.70 | $254.94 | $539.44 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |