| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $40.00 | $40.00 | $40.00 | |
Aetna
| Professional | $40.00 | $40.00 | $40.00 | |
Cigna
| Facility | $70.00 | $70.00 | $191.40 | |
Cigna
| Professional | $139.72 | $139.72 | $139.72 | |
Medcost
| Facility | $40.00 | $46.00 | $84.64 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |