| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1.26 | $1.26 | $1.26 | |
Aetna
| Professional | $1.26 | $1.26 | $1.26 | |
Cigna
| Facility | $171.21 | $171.21 | $269.14 | |
Cigna
| Professional | $196.48 | $196.48 | $196.48 | |
Medcost
| Facility | $1.26 | $1.45 | $2.67 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |