| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $75.00 | $75.00 | $75.00 | |
Aetna
| Professional | $75.00 | $75.00 | $75.00 | |
Cigna
| Facility | $70.00 | $70.00 | $134.61 | |
Cigna
| Professional | $98.27 | $98.27 | $98.27 | |
Medcost
| Facility | $75.00 | $86.25 | $158.69 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |