| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $39.81 | $39.81 | $39.81 | |
Aetna
| Professional | $39.81 | $39.81 | $39.81 | |
Cigna
| Professional | $141.25 | $141.25 | $141.25 | |
Medcost
| Facility | $39.81 | $42.66 | $67.61 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |