| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2.00 | $2.00 | $2.00 | |
Aetna
| Professional | $2.00 | $2.00 | $2.00 | |
Cigna
| Professional | $93.33 | $93.33 | $93.33 | |
Medcost
| Facility | $2.04 | $2.14 | $3.47 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |