| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1.00 | $1.00 | $1.00 | |
Aetna
| Professional | $1.00 | $1.00 | $1.00 | |
Cigna
| Professional | $194.98 | $194.98 | $194.98 | |
Medcost
| Facility | $1.26 | $1.35 | $2.14 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |