| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $75.86 | $75.86 | $75.86 | |
Cigna
| Facility | $64.57 | $64.57 | $64.57 | |
Cigna
| Professional | $2.69 | $2.69 | $2.69 | |
Medcost
| Facility | $0.30 | $0.30 | $0.54 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |