| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $10.00 | $10.00 | $10.00 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $21.03 | $21.03 | $21.03 | |
Medcost
| Facility | $10.00 | $10.00 | $17.00 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |